SLA Biomedical and Life Sciences Division

Nomination Form

Please select the award for which you are providing a nomination, followed by your name and email address, and then the nominee's personal and career information:

Distinguished Member Award

Winifred Sewell Prize

Your Name:
Your Email:

Nominee Personal Information
Name of Nominee
(self-nominations accepted):
Nominee's Address:
City:
   State:   Postal Code:
Country:
Phone:
Email:

Nominee Career Information
Nominee's Title:
Employer Name:
Employer's Address:
City:
   State:    Postal Code:
Country:
Is nominee retired?
 Yes    No

Division Information
Is nominee a DBIO member?
 Yes    No
Is nominee a Medical Section member?
 Yes    No
Has the nominee ever won a DBIO or SLA Award?
 Yes    No
If Yes, please list the award(s) and the year of receipt:

Please describe the nominee's activities, accomplishments, and contributions that support the criteria in the award description and explain, where applicable, the results and the impact of the nominee's efforts. Include details, such as dates and locations.

Also, forward the nomination form and nominee's bio or resume and other supporting documents, such as letters of recommendation, articles, and other commendations or recognition they have received to Howard Fuller, Awards Committee Co-Chair, no later than April 6 (prior to the SLA Conference).

Note: If nominee is deceased, please provide the name and address of closest survivor, year of death, and other information as appropriate.


Rev. June 2015