Form 1 SSSC Nomination form

Nomination Form
General Information
Please provide the following general information with your nomination.
omplete nomination package no later than

day,

Staff Scientist
1.

Nominee Name:
Degree(s):
Title:
Division:
Lab/Branch/Office:
Campus Address:
Work Email:
Length of time in this position:
Name of Nominee’s Supervisor:

,

.

2.

Primary Nominator Name:
Degree(s):
Division:
Lab/Branch/Office:
Campus Address:
Work E-mail:
Relationship to the Nominee:

Current Postdoctoral Fellow

How long has the Nominee been your mentor:

Less than 1 year

Your nomination is confidential. If your nominee is not selected as a winner, may we share your
identity and nomination with them?

3.

Yes

Secondary Nominator Name:
Degree(s):
Division:
Lab/Branch/Office:
Campus Address:
Work E-mail:
Relationship to the Nominee:

Current Postdoctoral Fellow

How long has the Nominee been your mentor:

Less than 1 year

Your nomination is confidential. If your nominee is not selected as a winner, may we share your
identity and nomination with them?

Yes

Review Criteria
Please answer ALL the following questions. Please use the full scale range (1-10 scale, 1 is low and 10
is high) to rate your nominee.
Communication (verbal and written):
1. How well does your mentor explain scientific concepts and methods to you?

1

2. How open is your mentor to answering your questions and encouraging scientific curiosity?

1

Accessibility:
1. How easily is your mentor available to you?

1

2. Does your mentor share his/her knowledge with you?

1

Visibility:
1. Does your mentor provide you an opportunity to present your work at workshops and
meetings (internal or external)?

1

2. Are you encouraged to write and publish your scientific findings?

1

Mentoring environment:
1. Does your mentor provide a conducive training environment, including intellectual and
tangible support for scientific development?

1

2. How clear is your mentor in his/her expectations of you?

1

Overall rating:
Please rate your mentor’s overall support/helpfulness to prepare for and meet your career objectives and
future aspirations/goals.

1

Please provide specific examples that demonstrate the nominee’s commitment to
mentoring

1.

2.

How has your mentor encouraged you to continue your scientific career Please describe.

Please provide specific examples that demonstrate the nominee’s commitment to

1.

mentoring

2.

How has your mentor encouraged you to continue your scientific career Please describe.