Henry Hill Award Application

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A Division of the American Chemical Society

Personal Information

Name of Nominee *First & Last Name

Nominee Email Address *

Nominee Phone *

Nominee ACS Membership Number *

Primary Nominator Name *First & Last Name

Primary Nominator Email Address *

Primary Nominator Phone *

Secondary Nominator Name *First & Last Name

Secondary Nominator Email Address *

Secondary Nominator Phone *

Upload CV/Resume of Nominee (PDF or Docx only.) *

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Primary Nominator Letter of Support (PDF or Docx only) *

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Secondary Nominator Letter of Support (PDF or Docx only) *

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I certify that the information provided is accurate and correct to the best of my knowledge. *Confirm

Your Initials *

Date *