ACS Chemical Technology Student Award Institution Report Form

Nominator:

Nominator First Name *

Nominator Last Name *

Institution: *

Program/Department: *

Chair/Head: *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Nominator Email Address *

Selection Committee Members:

Please add the name and email addresses of the selection committee members below: *

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Please confirm whether the selectee has fulfilled the eligibility requirements to receive the award (check all that apply). *

Is the selectee enrolled in a chemistry or chemistry-based technology program

Does the selectee aspire to work in the chemical or a related industry as a chemical technician or in another role

Will the selectee have completed 75% of the program coursework by the time the award is presented

Does the selectee demonstrate a high level of integrity and reliability

Does the selectee demonstrate exceptional performance in the laboratory (safety, experimental setup and design, data analysis, teamwork, and problem solving)

Exhibit strong oral and written communication skills

Demonstrate superior academic performance across all courses (consistently in the upper 10%)

Nominator Statement (please state why this student should be honored). *

0/100 characters

Award Winner Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Please submit this form by January 31, 2023.
If you have any questions/concerns please send them to:

cta@acs.org