Checklist for MSA Award or Medal Nominations (Please indicate one): [ ] Roebling Medal [ ] Distinguished Public Service Medal [ ] Dana Medal [ ] Mineralogical Society of America Award Date: _________________________________________________ **************************************** Nominee: _________________________________________________ Address: _________________________________________________ Address: _________________________________________________ phone: _________________________________________________ e-mail: _________________________________________________ Date of birth or date of most advanced degree for MSA Award nominess only: ______________ Sponsor: _________________________________________________ Address: _________________________________________________ Address: _________________________________________________ phone: _________________________________________________ e-mail: _________________________________________________ (There needs to be at least 3 but no more than 5 co-sponsors of the nomination) Co-Sponsor 1: _________________________________________________ Co-Sponsor 2: _________________________________________________ Co-Sponsor 3: _________________________________________________ Co-Sponsor 4: _________________________________________________ Co-Sponsor 5: _________________________________________________ **************************************** Required Information (1) this cover page (2) a cover letter from the nominator outlining the candidate's qualifications in light of the criteria for the award. (3) supporting letters from at least three (3) but no more than five (5) other individuals are required and should focus on how the candidate meets the criteria of the award. (4) curriculum vitae and a bibliography of published works exclusive of abstracts, book reviews, and papers that have not yet been accepted for publication. (5) any supplementary materials that bear on the award criteria. **************************************** The committee asks that the nominator compile into a single electronic file the nomination, all letters of support, and supplementary materials before submitting then nomination to the Committee Chair. This single electronic nomination package makes it easier and less expensive for the committee members, who are increasingly international, to do their work. The nomination package must be submitted to the chair of the respective Committee for the award by June 1. You can obtain their contact information by selecting: Roebling Medal Committee Distinguished Public Service Medal Committee Dana Medal Committee Mineralogical Society of America Award Committee or, you can send the nomination package to: MSA Business Office 3635 Concorde Pkwy Ste 500 Chantilly VA 20151-1125 o USA Tel: +1 (703) 652-9950 Fax: +1 (703) 652-9951 e-mail: business@minsocam.org Internet: www.minsocam.org. Nominations can be carried over to following years if the nomination package is updated by the sponsor. Any nomination not renewed after 2 years will be not considered further. (revised 10/24/2005) Copyright (c) 1997 - 2004 Mineralogical Society of America. All rights reserved