Australian Academy of Science
2019 Honorific Awards for scientific excellence
GOTTSCHALK MEDAL
NOMINATION FORM
Award criteria
· The Gottschalk Medal recognises outstanding research in the medical sciences.
· It is awarded to early-career researchers up to 10 years post PhD (or equivalent first higher degree e.g. D.Phil., D. Psych., D.Sc.) in the calendar year of nomination, except in the case of significant interruptions to a research career.
· It is restricted to candidates who are normally resident in Australia and for research conducted mainly in Australia.
To assist you in filling out this form, please see the Guide for Nominators.
1. Full name, professional position and address of candidate:
Telephone:
E-mail:
Nationality/ies:
Date of birth:
Gender:
Male Prefer not to state
Female Other:……………………
Australian Residency status:
2. Name and address of nominator(s):
Telephone: E-mail:
3. Non-Technical Description of the Work (Around 150 words)
4. Brief citation (1 page) (see Guide for Nominators for further information):
5. Essential documentation (please tick to indicate documentation provided) (see Guide):
5.1 Candidate's detailed curriculum vitae r
5.2 List of 20 of the candidate’s publications relevant to the award r
5.3 (If applicable) Early Career award – eligibility extension request r
6. Signature of nominator(s)
Date:
NB: if other nominators wish to endorse this nomination, please do so by email to if not available to sign this form.
7. Referee reports (see Guide for Nominators):
(Please attach referee reports at the end of the nomination or have referees submit this directly to by the referee report deadline, informing you when they have done so. Please note that nominations are not complete until these references have been received and it is up to the nominator to ensure that all documentation has been received by the deadline).
8. Lodging the nomination form
Send this nomination form to:
Australian Academy of Science Awards
E-mail:
Mail: GPO Box 783, CANBERRA ACT 2601
An electronic copy sent by e-mail is preferred. Receipt of the nomination will be acknowledged.
The Award recipient will be announced in early November. For more information about the nomination process, contact the Grants Administration Officer, at call + 61 (0)2 6201 9412.
9. Please help us by stating where you heard of this award round.
Closing date for nominations: 9:00am (AEST) 1 May 2018
Closing date for referee reports: 9:00am (AEST) 1 June 2018
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Privacy statement
The Australian Academy of Science (the Academy) is an ‘agency’ for the purposes of the Privacy Act 1988 (Cth) and as such complies with the obligations of the Privacy Act within that meaning. The Academy strives to achieve diversity and equity of participants in the activities that it undertakes, and as such, it monitors the effectiveness of its activities by collecting gender, age and nationality information related to participants of the Award programs.
The Academy acknowledges the complex nature of gender identity and diversity in the broadest meaning.
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