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The American Society for Clinical Laboratory Science
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Membership
Benefits
Constituent Societies
Join
Renew
Membership Packages
Education
Annual Meeting
Registration
Accommodations
Poster Abstract Submissions
CLEC
Registration
Poster Information
Accommodations
Partner Engagement
eCLECtic Blog
Webcasts-Webinars
Webinars
Educator Resources
Laboratory Educators Institute
Manager Resources
ELMC2
CE Organizer Data Transfer
Labucate Virtual Learning
Online P.A.C.E. Courses
Labvocate Symposium
Communication
Social Media
Society News Now
ASCLS Today
Podcasts
ASCLS Connect Community
eNewsBytes
Clinical Laboratory Science Journal
The Bench Connection
Participate
Forums
Ascending Professionals Forum
Developing Professionals Forum
Diversity Advocacy Council
PRISM
House of Delegates
Constituent Societies
Regional Councils
Committees
Governance Resources
Volunteer Opportunities
Scientific Assemblies
Lab Week-MLPW
Mentorship Program
Advocacy-Issues
Legislative Symposium
Licensure
Workforce
ASCLS Political Action Committee
Patient Safety
Labvocate Action Center
Position Papers
Careers
Career Center
Career Center – Job Search
Career Center – Employers
How do I become a laboratory professional?
Online Academic Programs
Certification Information
DCLS
DCLS Body of Knowledge
Career Recruitment Tool Kit
Laboratory Science Careers Website
P.A.C.E.
PACE Home
PACE Providers List
Online P.A.C.E. Courses
About Us
Mission Vision Statement
Code of Ethics
Board of Directors
Leadership
Leadership Directories
Leadership Resources
House of Delegates
Past Presidents
Professional Staff
Awards and Scholarships
Education & Research Fund
History
Industry Support
ASCLS Voices Under 40
Calendar
ASCLS Awards Application and Nomination
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ASCLS Awards Application and Nomination
Choose Award
*
Ascending Professional Leadership Award
Constituent Society Member of the Year Recognition
Developing Professional Leadership Award
Lifetime Achievement Award
Society Electronic Publication Award
Society Paper Publication Award
Scientific Research Award
Society Website Award
Theriot Award
Voices Under 40
Please select the award for which you are applying or nominating.
Award Applicants/Nominee Information
Applicant/Nominee Name (As it should appear on the award)
*
First
Last
Constitutent Society or Region
*
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
ASCLS Member Number
*
ASCLS Join Year
Year Started Working as Professional
2022
2021
2020
2019
2018
2017
2016
Co-Applicant/Nominee Name (As it should appear on the award)
First
Last
Nominator Information
Please fill in all required fields, including those self-nominating/submitting for an award.
Nominator Name
*
First
Last
Constitutent Society or Region
*
Constitutent Society or Regional Position
*
Nominator Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Nominator Email
*
Nominator Phone
*
Promotion of the Profession Fundraising Detail
Please describe the amount raised, the recipient of the donation, and description of how the funds were raised.
File Uploads (if applicable)
Upload Attachment 1 (needed for Lifetime Achievement, Ascending Professional Leadership, Developing Professional Leadership)
*Attachment required to be considered for Lifetime Achievement, Ascending Professional Leadership, or Developing Professional Leadership Awards 4MB maximum file size. PDF or Word document only.
Accepted file types: pdf, doc, Max. file size: 4 MB.
Upload Attachment 2 (needed for Lifetime Achievement, Ascending Professional Leadership)
*Attachment required to be considered for Lifetime Achievement or Ascending Professional Leadership Awards. 4MB maximum file size. PDF or Word document only.
Accepted file types: pdf, doc, Max. file size: 4 MB.
Upload Attachment 3 (needed for Developing Professional Leadership)
*Attachment required to be considered for Developing Professional Leadership Award 4MB maximum file size. PDF or Word document only.
Accepted file types: pdf, doc, Max. file size: 4 MB.
Upload Letter of Nomination
4MB maximum file size. PDF or Word document only.
Accepted file types: pdf, doc, Max. file size: 4 MB.
Websites and Publications
Website Address/URL
Publication Name
Publication Issue 1
Volume and Number. PDF will be submitted below.
Upload PDF of Issue 1
4MB maximum file size. PDF only.
Accepted file types: pdf, Max. file size: 4 MB.
Publication Issue 2
Volume and Number. PDF will be submitted below.
Upload PDF of Issue 2
4MB maximum file size. PDF only.
Accepted file types: pdf, Max. file size: 4 MB.
Publication URL for Issue 1
Publication URL for Issue 2
Scientific Awards
Please fill in all required fields, including those self-nominating/submitting for an award.
Title of Project
Short Description of Project Subject Matter Presented
Project Entry Category
Written
Mechanical
Graphic
Online
Other
Coauthors or Project Collaborators
Please copy and paste the names (as they should appear), ASCLS member numbers, and email addresses of any coauthors or project collaborators.
Has the research project been done in the last two (2) years?
Yes
No
Scientific Research Award File Upload
Upload a PDF or Word document with an explanation, in fewer than 300 words, of the impact of this project on patient care and current laboratory science practice.
Accepted file types: pdf, doc, Max. file size: 4 MB.
Theriot Award File Upload
Upload copy of materials or example of materials.
Max. file size: 360 MB.
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