FEDERAL LABORATORY CONSORTIUM FOR

TECHNOLOGY TRANSFER

MIDWEST REGION

2016

REGIONAL APPRECIATION AWARD

REGIONAL APPRECIATION AWARD—SPECIAL SERVICE AWARD

(FLC National Outstanding Service Award)

This regional award is given to an individual who has made a significant contribution to the federal technology transfer program. The act, effort, or support must have been for the primary purpose of promoting and/or extending technology transfer from the federal laboratory system to nonfederal entities. The individual selected for this award will be the Region's nominee for the FLC national Outstanding Service Award.

Eligibility

  • The nominee may not be a Laboratory Representative or Alternate, but may be an advisor, government official, university contact, etc.
  • The nominee has provided sustained support/service to the FLC as an organization.
  • The contribution took place within the past three years.
  • The nominee has not previously received the award.

Criteria

  • The nominee must have demonstrated exceptional or unique efforts or processes to promote technology transfer.
  • The primary beneficiaries of the nominee’s actions (in terms of improving technology transfer effectiveness) must be federal laboratories, nonfederal entities receiving federal technologies, or a combination of the two.
  • The actions of the nominee must have had an impact on the federal technology transfer program in a discernable manner.

Nomination

  • Nominations for this award can be submitted by a designated FLC Laboratory Representative or Alternate only.
  • The person making the nomination does not have to be part of, or reside in, the region where the nominee resides.
  • The nominations must be submitted to the Midwest Region Awards Chair.

Evaluation

  • Nominees will be evaluated on a scale of 100 points. Total points will be the sum of points given in each category.

Efforts or processes developed (35 points)

Significance of the efforts or processes to the beneficiaries (35 points)

Potential impact on the national technology transfer program (30 points).

Midwest Region

2016Regional Appreciation Award - Nomination Form

Nominator Information

Name:

Affiliation:

Phone:Fax:

E-mail:

Nominee Information

Nominee Name:

Affiliation:

Address:

Phone:Fax:

E-mail:

Please provide written responses to each of the evaluation criteria listed in the award description. Nominations must be submitted electronically to o later than

June 3, 2016.

Narrative

Please provide detailed information on the nomination in the appropriate areas indicated below:

Efforts or processes developed (35 points)

Significance of the efforts or processes to the beneficiaries (35 points)

Potential impact on the national technology transfer program (30 points)

1 2016 MW Regional AppreciationAward