" /> Nomination Form « Southeast Compact Commission – Low-Level Radioactive Waste Management
NOMINATION FORM
THE RICHARD S. HODES, M.D.

HONOR LECTURE AWARD
2017

THE DEADLINE FOR SUBMISSION IS AUGUST 31, 2016.

THE COMMISSION ENCOURAGES ELECTRONIC SUBMISSION OF ALL NOMINATION MATERIALS.

Submit nominations to:
Awards Committee
c/o Ted Buckner, Executive Director
Southeast Compact Commission
Post Office Box 5427
Cary, NC  27512
 
Phone:  (919) 380-7780
Email:  (secc (at) secompact (dot) org) secc (at) secompact (dot) org

Please complete the application below and email to the Southeast Compact Commission.

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Name of Nominee

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Present Position/Exact Title

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Company/Organization/Institution

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Address

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City                            State                           Zip Code          

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Phone

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E-mail

  

Citation
Provide a brief statement, not to exceed 100 words, describing the major innovation(s) for which the nomination is being made.

Basis for Nomination
Please include a statement, not to exceed 750 words, on why the innovation deserves special recognition.

Support Letters
Submit no more than three brief supporting letters from colleagues, peers, or former students.  Please do not attach exhibits, samples, etc. Voluminous materials are not useful to the selection committee.

 

 

Nominator Information

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Name

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Present Position/Exact Title

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Company/Organization/Institution

__________________________________________________________________
Address

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City                                       State/Province                        Zip/Postal Code              Country

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Business Phone, Fax, and E-mail Address

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Signature

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Date