National Chemical Technician Award Candidate Form

National Chemical Technician Award Candidate Form

National Chemical Technician Award Candidate Form

National Chemical Technician Award Renomination Form

Thank you for your participation in the National Chemical Technician Award program.Candidates who were originally nominated in the previous two years can be renominated via completion of this form. The renomination form will be added to the candidate’s original packet. If the original nomination packet is more than two years old, please start a new nomination packet using the NCTA Nomination Form.

Nominators are encouraged to provide updates on the candidates for any of the award criteria. Preferably, updates are only one page. Renomination forms exceeding two pages in length or containing proprietary, confidential, or private information will not be accepted.

Remember that the candidates are judged on the following criteria:

  • Technical Achievements (worth 60%)
  • Other (Considered together to make up the remaining 40%)
  • Leadership/Mentoring (15%)
  • Number of communications/publications (5%) Please do not include titles.
  • External publications, presentations, patents
  • Internal presentations, publications (can include SOPs, presentation to teams, etc.)
  • Contribution to quality, safety, and other initiatives (5%)
  • Awards (5%)
  • Professional and community activities (ACS, AIChE, outreach, etc.) (10%)

[Note: this cover page is not considered part of the renomination form and should be deleted or recycled prior to submitting the packet.]

Renomination formsmust be received by September 30, 2013.

Mark O’Brien

Staff Liaison, ACS Committee on Technician Affairs (CTA)

American Chemical Society

1155 Sixteenth St. NW

Washington, DC20036

1-800-227-5558, ext. 8212 (office) | 202-872-4353 (fax)

Contact Mark O’Brien (1-800-227-5558, ext. 8212, ) with any questions or concerns.

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National Chemical Technician Award Candidate Form

Candidate information

Name: / Title:
Company name:
Complete work address:
Work phone: / Email:
Year in which candidate was originally nominated: / 2007 2008
If candidate was first nominated prior to 2007, please resubmit nomination using the NCTA nomination form

Candidate’s immediate supervisor’s information

Supervisor’s name: / Supervisor’s title:
Work Phone: / Email:

Nominator’s information

Nominator’s name: / Nominator’s title:
Work Phone: / Email:

Candidate Eligibility

All three boxes in the Eligible column must be checked for candidate to be eligible.

Eligible / Ineligible
  1. Is the candidate a chemistry-based laboratory technician, process technician, operator, analyst, or other applied chemical technology professional?
/ Yes / No
  1. Has the candidate been employed for at least five years as an applied chemical technology professional?
/ Yes / No
  1. Is the candidate currently a member of the Committee on Technician Affairs Executive Board and/or Advocacy & Public Relations Subcommittee?
/ No / Yes

Updates

Include any additional or updated information that you would like added to the original nomination packet. Make space as necessary, but do not exceed 2 pages, minimum 10-point font. Do not include proprietary, confidential, or private information.

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