Camille Dreyfus Teacher-Scholar Awards Program ALL FIELDS ARE REQUIRED EXCEPT WHERE NOTED INSTITUTION NOMINEE First Name Last Name Position Year of First Academic Appointment Department Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Office Phone Email Nominee’s Faculty Website Field of Research (Key Words) (≤ 20 Words) You have used 0, and have 20 words remaining. UNDERGRADUATE EDUCATION Institution Year Department DOCTORAL EDUCATION Institution Year Advisor Department POSTDOCTORAL EDUCATION Institution Year Advisor Department SECOND POSTDOCTORAL EDUCATION (IF APPLICABLE) Institution Year Advisor Department NOMINATOR INFORMATION First Name Last Name Title Department Phone Email Address Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip SUPPORTING LETTERS REQUESTED FROM Name Email Institution (≤ 40 Characters) 0 Name Email Institution (≤ 40 Characters) 0 Name Email Institution (≤ 40 Characters) 0 INSTITUTIONAL CONTACT (development, foundation relations, sponsored research etc.) Full Name Email Address DESCRIPTION OF RESEARCH TITLE (≤ 15 WORDS) You have used 0, and have 15 words remaining. ABSTRACT (≤ 50 WORDS) You have used 0, and have 50 words remaining.
