Personal InformationName *First & Last NamePronouns (optional)Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweEmail Address *Phone *ACS Membership Number *Graduate School InformationName of Current Institution *Campus Location *University Email Address *ApplicationUpload CV/Resume (PDF or Docx only.) *Choose FileNo file chosenDelete uploaded fileLetter of Recommendation (PDF or Docx only)Choose FileNo file chosenDelete uploaded fileNote: A letter of recommendation is optional but strongly encouraged. If the recommender prefers to submit the letter themselves, they can send an email to pride@acsprof.org and CC awards@acsprof.org. Please note that the recommender should not have any conflict of interest and they do not need to be your PI.Proof of enrollment (pdf or doc/docx only) *Choose FileNo file chosenDelete uploaded filePlease provide proof of enrollment at a US-based institution for graduate studiesResearch AbstractAbstract Title *Abstract *0 / 2500Personal StatementsPersonal Statement. This statement should reflect your journey as an LGBTQ+ individual. Personal statements should be no more than 500 words in length. This statement should include: 1. Description of lived experiences being part of the LGBTQ+ communities, 2. Candidates are encouraged to include any volunteer experiences that foxus on LGBTQ+ issues but are not required to do so. *3000 character limit0 / 500Write a short statement about a challenge you've faced as a chemist and how you've dealt with that challenge (250 word limit)) *0 / 250How do you see your legacy in your chosen community in the future? (250 word limit) *0 / 250Future Career AspirationsPlease describe in a statement (250 word limit) where you envision your professional journey going and what you hope your career will look like in the future. *0 / 250Attendance at spring meeting *I acknowledge that I can attend the ACS Spring meeting in person.By selecting this box, I acknowledge that accepting this award will include sharing my name and likeness with the Division of Professional Relations and the ACS PRIDE subdivision. The purpose of this use is to further promote the award and the recipient and help grow their professional career. *Please select an optionYesNoI certify that the information provided is accurate and correct to the best of my knowledge. *ConfirmYour Initials *Date *Submit ApplicationSave as Draft
