The Distinguished Scientific Achievement Award is a prestigious award honoring a scientist who has made a major contribution to liver disease research in basic science or in its application towards the prevention, treatment or cure of
liver disease.
Nominee Name:_________________________________________ Organization/Institution of Nominee:___________________________________
Mailing Address and Contact Information for Nominee
Street: __________________________________________________________________ Street 2: __________________________________________________________________ City: _______________________________ State: _______________________________ Zip: _____________ Telephone: ___________________ Email Address:_________________________________
This nomination is being submitted by (name): __________________________________________ Organization/Institution of Individual Submitting this Nomination:________________________________
Mailing Address and Contact Information for the Individual Submitting this Nomination
Street: __________________________________________________________________ Street 2: __________________________________________________________________ City: _______________________________ State: _______________________________ Zip: _____________ Daytime Telephone: ___________________ Email Address:_________________________________
Attachments Required:
1. Letter of recommendation -‐ Attach a detailed letter of no more than two pages, on why you think this personshould receive the Distinguished Scientific Achievement Award.
2. Nominee’s full Curriculum Vitae
Previous recipients of this award can be found at the webpage be below: http://www.liverfoundation.org/medical-professionals/alf-research-awards-program
To submit a nomination, fill out this form and send it along with required documents via email to Megan Glynn at [email protected]
For further information, contact Megan Glynn at 646-737-9402 or via email: [email protected]
Incomplete nominations and late nominations will not be accepted.