Columbus Foundation Christopher Columbus Foundation-U.S. Chamber of Commerce Life Sciences Awards U.S. Chamber of Commerce


$10,000 Distinguished Life Sciences Scientist Award

2012 NOMINATION FORM

Deadline for Submission: Tuesday, March 27, 2012

2012 Christopher Columbus Foundation-U.S. Chamber of Commerce Life Sciences Awards

PURPOSE:

The Life Sciences Awards are designed to encourage and promote "cutting-edge" innovation in the field of life sciences. Monetary awards will be presented to an adult scientist; a current high school educator; and two high school students.

ELIGIBILITY AND SELECTION PROCESS:

This is a competition NOT a grant application. Individuals will compete and their accomplishments will be judged on how they exemplify excellence in life sciences.

$10,000 Distinguished Life Sciences Scientist Award

The $10,000 Distinguished Life Sciences Scientist Award will be presented to a scientist who is making or has recently made a significant and positive contribution toward the development of a "cutting edge" innovation in the field of life sciences.

Criteria

  1. All Nominees must be living United States citizens.
  2. The Nomination must demonstrate a program of ongoing work with a specific outcome suggesting that an important achievement will result.
  3. The Nomination’s proposed achievement must benefit human health in a unique and effective manner, demonstrating originality from other work in the same or related field(s).
  4. The proposed achievement must correlate to a tangible outcome to advance human health.
  5. Any Nomination that does not meet the above stated criteria will be disqualified.

NOMINATION MATERIALS:

  1. If a Nomination is selected as a semifinalist, the Nominator will be notified and asked to provide copies of supporting materials.
  2. All Nominations and materials submitted in connection with the Life Sciences Awards and any reproductions made therefrom, shall be solely, exclusively and entirely the property of the Foundation and shall not be returned.
  3. The Foundation shall have the sole and exclusive right to use, and permit others to use, the above stated Nomination and materials including the candidate’s name, likeness, and other biographical information and promotions, news releases and advertising in connection with either present or future Foundation programs or similar programs or awards. All materials submitted become the property of the Foundation without any compensation to the candidate, however, the Foundation does not claim ownership of the "intellectual property" submitted.

 

ADDITIONAL RULES:

Nominees must be permitted to accept a monetary award bestowed by the Foundation, a Federal government agency.

Awards may be taxable income to the recipient. All tax liabilities are the sole responsibility of the winner. All Federal, State and local laws and regulations apply.

Winners must attend the awards ceremony on July 2012 in Washington, D.C., in order to receive the award. Anyone who cannot attend the awards ceremony will automatically be disqualified.

Nominations are received online ONLY at: www.ccolumbusfoundationawards.org. The deadline for submissions is Tuesday, March 27, 2012.

The Foundation reserves the right to cancel or change the Life Sciences Awards Program at any time at its full discretion.

  Check here acknowledging you have read and understand the rules of eligibility.

By checking this box, you certify that you meet all eligibility requirements.

NOTE:

  1. It is important that you answer EVERY question before hitting the "Send Nomination" button. Otherwise, your information may be lost.
  2. Cookies must be turned on in your browser if you decide to save your work and return to your Nomination form at a later date.
  3. Please complete the following in language as simple as possible.
  4. * Indicates a required field.

2012 Christopher Columbus Foundation-U.S. Chamber of Commerce Life Sciences Awards

  1. THE CANDIDATE
    Fields:
    Salutation*First Name *Last Name
    *Title:
    *Company/University/Affiliation:
    *Office Address:
    Office Apt/Condo #:
    *City:
    *State:
    *Zip:
    *Office Phone:
    Cell:
    Fax:
    *Email: (Please enter one address only!)


    2. Note:
    In the first round of judging, Judges only see answers to questions 1, 2, and 3 so it is extremely important that you describe your work in simple and concise language in these three sections. This is your only chance to introduce your important work to the Judges and have an opportunity to be selected to move to the second round of judging. However, all questions on the Nomination Form must be completed.

  2. *Briefly describe your work:


  3. *Characterize your work in 100 words or less:


  4. *Please elaborate on your accomplishments and specify how they have exemplified excellence in the field of life sciences:


  5. *Candidate's Education/Degree(s):


  6. *Other note-worthy accomplishments:


  7. *Previous Honors and Awards (please limit to top five awards):


  8. *List the names, titles, affiliations and phone numbers of THREE professional peers who we can call upon as references.


  9. THE NOMINATOR
    Are the Candidate and the Nominator the same person?
    Yes (If 'Yes', skip to question #10.)
    No
    SalutationFirst NameLast Name
    Title:
    Company:
    Address:
    Apt/Condo #:
    City:
    State:
    Zip:
    Office Phone:
    Cell (optional):
    Fax (optional):
    Email: (Please enter one address only!)


  10. *How did you hear about the Life Sciences Awards?


    11. If you believe that all information is complete you may send the Nomination now. We will do a quick check for necessary information, and if all is included, we will send you an email verifying your Nomination has been received.

    Send me an Email of the completed form:

    If all necessary information is not yet complete you may save your work below. To save your work you must minimally fill out the name of the candidate and all of your contact information, either as the nominator or candidate. You can then use your Email address and a Password of your choice (below) to retrieve and complete this application at a later date:
    Desired Password:

Please submit this form by Tuesday, March 27, 2012.

NOTE: If your Nomination is selected as a semifinalist, we will notify the Nominator and request copies of supporting materials.

Questions? Contact Judith Shellenberger at judithmscolumbus@cs.com
Purpose, Eligibility, Selection Process and Application Materials  |   Christopher Columbus Foundation
2011 Life Sciences Award Columbus Scholars  |   Past Life Sciences Awards Columbus Scholars
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