Candidate's Name *

Candidate’s Position and Affiliation (include complete mailing address, phone number, and email): *

Candidate’s Home Address (include complete mailing address, phone number, and email): *

First Name *

Last Name *

Email *

Phone *

Organization *

Title *

Nominator's Written Statement

Please evaluate the candidate’s ability to communicate research findings to the public. This should include a list of relevant publications, public speaking engagements, television and radio appearances, social media activities, and other media involvement from the past five years. Please include links to the respective documents.

20MB max

Letter 1 *

20MB max

Letter 2 *

20MB max

Letter 3 *

20MB max

Letter 4 *

20MB max

Letter 5 *

20MB max