Word File for 2007 MCI Award of Encouragement

MITSUI CHEMICALS CATALYSIS SCIENCE AWARD

OF ENCOURAGEMENTNOMINATION FORM

This is the nomination form for the “Mitsui Chemicals Catalysis Science Awardof Encouragement” which includes:

1)Nominator Information (sealed with Letter of Recommendation)

2)Letter of Recommendation from Nominator*

3)Nominee Information(3 copies)

4)Nominee’s Statement for Application(3)

5)List of Publications and Patents(3)

6)Biographical Sketch(3)

7)CD-R or DVD-R included the above data (3-6)(1)

8)Three Key Publications(3 each)

* Any individual can nominate onlyone nominee during any given award year.

Directions:

All the nomination form has to be completed by the nominee, except for the Letter of Recommendation from Nominator, which has to be prepared and sealed by the nominator.Complete the form in English. Any language but English is not acceptable.

Please mail the completed nomination form with the Letter of Recommendation from Nominator, one CD-R or DVD-Rand the reprints (or copies) of your three key publications to the address below by December 28, 2015.

Please mail the totalthree (3) copies of the documents above, EXCEPT for the Letter of Recommendation from Nominator and the Nominator Information.

Application by other than mail will NOT be acceptable.

Mailing Address:

The Catalysis Science Award Selection Committee

R&D Strategy Division

Mitsui Chemicals, Inc.

ShiodomeCityCenter, 1-5-2, Higashi-Shimbashi

Minato-ku, Tokyo 105-7122, JAPAN

Notices:

•The entry to the award has to be done with a permission of collaborators, if any.

•The submitted documents will not be returned.

•The winners of the "2016Mitsui Chemicals Catalysis Science Awardof Encouragement" will be requested to deliver commemorative lectures in autumn 2016. Details of the commemorative lectures will be announced later.The travel expenses including accommodation charges to the Symposium will be paid.

Use of Personal Information:

Mitsui Chemicals, Inc. uses the personal information written in thisnomination form to select and announce the winners.In principle, the personal information Mitsui Chemicals, Inc. obtains through this formis used only for the purpose stated above.

Mitsui Chemicals, Inc.will not provide the personal information to any third party without obtaining prior consent of applicants except the case stated in laws.

NOMINATOR INFORMATION

First Name:

Middle Initial:

Last Name:

Institutional Affiliation:

Present Position (Exact Title):

Address:

City:

State:

Zip:

Country:

Telephone:

Fax:

E-mail:

RECOMMENDATION BY NOMINATORfor the “Mitsui Chemicals Catalysis Science Awardof Encouragement”

Provide a summary of 500 words or less.

Signature:

Date:
NOMINEE INFORMATION

First Name:

Middle Initial:

Last Name:

Institutional Affiliation:

Present Position (Exact Title):

Address:

City:

State:

Zip:

Country:

Telephone:

Fax:

E-mail:

Date of Birth:

Age (at the date of April 1,2015):

Signature:

Date:

Nominee’s research field

Please choose the nominee’s research field on the following two categories.

(1) Homogeneous Catalyst

Heterogeneous Catalyst

(2) Specialty Chemicals Bulk Chemicals

Polymers Others :

NOMINEE’S STATEMENT FOR APPLICATION (1/#)

Entitle and provide a statement in 2,000 words or less with the following items (i)-(v) in different paragraphs. Use additional sheet if required.

(i)The title of your achievements

(ii)Evaluate the nominee’s accomplishments and specific identification of the work to be recognized.

(iii)Explain why the nominee is qualified for this award in terms of the contribution and the influence of his/her accomplishments to chemistry and the chemical industry.

(iv)Describe the key publications up to 5 articles.

(v)If the nominee is not the sole author of the works, specify his/her contribution.

※If the nominee had received any other award for the same accomplishments, describe the name and the year of the award.

NOMINEE’S STATEMENT FOR APPLICATION (2/#)

LIST OF PUBLICATION AND PATENTS

Paste the nominee’s publications and patents list.

BIOGRAPHICAL SKETCH

Paste the nominee’s biographical sketch (curriculum vitae).

2016MCI CATALYSIS SCIENCE AWARDOF ENCOURAGEMENTNOMINATION FORM1/8