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*
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*
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
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.

ASCLS Awards Application and Nomination

Award Applicants/Nominee Information

Nominator Information

File Uploads (if applicable)

Websites and Publications

Scientific Awards