ASCLS Awards Application and Nomination

Choose Award*
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*
Group Represented
Address*
Street Address City State ZIP Code
Phone*
Email*
ASCLS Member Number*
ASCLS Join Year
Year Started Working as Professional
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 State ZIP Code
Nominator Email*
Nominator Phone
File Uploads (if applicable)
Upload Attachment 1 (needed for Pinnacle Award, Ascending Professional Leadership, Developing Professional Leadership)
*Attachment required to be considered for Pinnacle Award, 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 Pinnacle Award)
*Attachment required to be considered for Pinnacle Award 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 Attachment 4 (needed for Ascending 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, Personal Statement, or Letter of Support
4MB maximum file size. PDF or Word document only.
Accepted file types: pdf, doc, Max. file size: 4 MB.
Community Engagement
Share documentation of your community engagement as original content files that you upload or links to original content online. You may submit in either or both formats.
Upload original digital content you'd like to showcase
360MB maximum file size.
Drop files here or

Max. file size: 128 MB.
Share URLs to websites, social media posts, e-portfoloios, or other original digital content you'd like to showcase
Why do you feel this original content is deserving of a community engagement award?
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
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: 128 MB.
File
Max. file size: 128 MB.

ASCLS Awards Application and Nomination

Award Applicants/Nominee Information

Nominator Information

File Uploads (if applicable)

Community Engagement

Scientific Awards

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