2011 FLC ROOKIE OF THE YEAR AWARD NOMINATION FORM

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1 2011 FLC ROOKIE OF THE YEAR AWARD NOMINATION FORM

2 ******* DEADLINE FOR SUBMISSIONS: THURSDAY, OCTOBER 14, 2010 ******* Nomination Form The FLC Rookie of the Year Award recognizes the efforts of an FLC laboratory technology transfer professional who has demonstrated outstanding work in the field of technology transfer in a manner significantly over and above what was called for in the normal course of their work during the past year. The nominee must be new to technology transfer with three years (or less) experience in a technology transfer position. THIS IS A NEW AWARD SO READ ALL THE GUIDELINES CAREFULLY. USE THIS FORM ONLY THERE ARE NO PREVIOUS FORMS PLEASE READ CAREFULLY TO AVOID HAVING YOUR SUBMISSION DISQUALIFIED. Award Criteria Nominees of the will be judged on the following criteria: 1. The Nominee must have demonstrated exceptional service performing their technology transfer professional responsibilities within their organization over the past year. 2. The nomination must provide a clear explanation of the innovative approach or creativity to addressing a need and demonstrable results. 3. The nomination must describe the specific roles, goals, objectives and contributions of the nominee. 4. The nomination must describe what has been the impact to date and how that impact is determined. I

3 ******* DEADLINE FOR SUBMISSIONS: THURSDAY, OCTOBER 14, 2010 ******* Submission Guidelines Nominee must work in direct support of an FLC laboratory. Nomination narrative should not exceed three pages. Use Arial or Times font styles that are no smaller than 10 points. Do not attach supporting documentation (e.g. brochures, newspaper articles, press releases). Do not include links to websites, homepages, etc. Section A and Section B of the nomination form must be sent electronically to the FLC Management Support Office at mchambers@utrs.com. Section C of the Submission Verification form must be signed by the individual submitting the nomination and it must be faxed to the FLC Management Support Office (attn: Michele Chambers) at Submission Deadline Both the Nomination form and Submission Verification form must be received by the FLC Management Support Office by 8:00 p.m. EDT (5:00 p.m. PDT) on Thursday, October 14, No submissions will be accepted after this time. Announcement of Results The winner(s) of the will be announced on December 16, Laboratories submitting nominations will be notified prior to the official announcement. Award Ceremony Winner(s) will be honored during an awards banquet to be held May 5, 2011 at the FLC National Meeting in Nashville, TN. II

4 FOR FLC USE ONLY DO NOT COMPLETE OR REMOVE RECEIVED: SUBMISSION NUMBER: Section A Contact Information NOMINEE #1 INFORMATION NOMINEE #2 INFORMATION (if you plan to submit more than two nominees for this award, provide the contact information on the following page) NOMINATOR INFORMATION A-1

5 NOMINEE #3 INFORMATION NOMINEE #4 INFORMATION NOMINEE #5 INFORMATION A-2

6 Section B Nomination Narrative B-1

7 B-2

8 B-3

9 Section C Submission Verification (This page will only be accepted via fax at ) NOMINEES: Only include names and organizations NOMINATOR INFORMATION: Laboratory: Phone: Fax: I hereby confirm that Section A and Section B of the FLC Rookie of the Year Award Nomination Form have been sent electronically to the FLC Management Support Office for judging. Nominator Signature: Date: C-1