AAAS Mentor Awards
DEADLINE: AUGUST 15
Please type or print. (Photocopies of this form are acceptable)
CATEGORY OF APPLICATION (please check one)
Lifetime Mentor Award (25 years or longer)
Mentor Award (less than 25 years)
YEAR OF NOMINATION:
ABOUT THE CANDIDATE:
Name
Position
Institution
Professional Address
City
Professional Phone
Home Address
City
Home Phone
Are you a AAAS Member?
State
Professional Fax
Yes
No
Zip
State
Zip
E-mail
If Yes, which section do you belong to? ______________________
Which of the following categories describe the candidate? (Optional)
Asian
Black or African-American
American Indian or Alaska Native
Hispanic, Latino, or Spanish Origin
Native Hawaiian or Pacific Islander
White
Other race, ethnicity, or origin
Prefer not to answer
Which of the following categories describe the candidate? (Optional)
Female
Male
Prefer not to answer
All nominations must include:
 Summary of actions that form the basis for the nomination
(about 250 words).
 A letter of nomination that enumerates the ways in which the
person reflects the purpose of this award, including scholarship,
activism, and community building.
 Curriculum vitae of nominee (3 page maximum).
 A list of students mentored with year PhD earned, institution
and current employment (page 2 & 3).
 A maximum of five supporting letters from students and three
supporting letters from colleagues, representative of the
difference spheres in which the candidate has demonstrated
effort, results and commitment
 Nominations must be made in English.
Number of underrepresented students
the candidate mentored at the bachelor’s
or masters level, who went on to
complete doctoral level at other institution:
Total number of underrepresented
students the candidate mentored
through completion at the doctoral level:
ABOUT THE NOMINATOR:
Name
Position
Institution
Professional Address
City
Professional Phone
E-mail
Are you a AAAS Member?
State
Professional Fax
Yes
No
Zip
If Yes, which section do you belong to? ______________________
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AAAS Mentor Awards
DEADLINE: AUGUST 15
Which of the following categories describe the nominator? (Optional)
Asian
Black or African-American
American Indian or Alaska Native
Hispanic, Latino, or Spanish Origin
Native Hawaiian or Pacific Islander
White
Other race, ethnicity, or origin
Prefer not to answer
Which of the following categories describe the nominator? (Optional)
Female
Male
Prefer not to answer
PLEASE NOTE:
APPLICATION SUBMISSION:
Mentor Award nominations MUST be received no later
than August 15. Any nominations or supporting materials
received after August 15 will not be considered for the
Mentor Awards.
Please submit this application and accompanying materials via
email to Ysabel Woody ([email protected]) and Neela White
([email protected]). Please contact Ysabel Woody if you need
to submit a paper application or via fax.
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