Undergraduate Award Program Application for Digital Delivery

Undergraduate Award Program - Digital Delivery

All international institutions and those United States institutions willing to print their own certificates and award letters are required to complete this form. We will send the PDF version of the Certificate and Letter to the nominator within 24 hours.

"*" indicates required fields

New starting in 2022: All schools may nominate a second extraordinary student when they include consideration in areas such as race, ethnicity, nationality, socioeconomic status, non-traditional gender identification or sexual orientation, religious affiliation, or (dis)ability. Please note that data obtained by ACS on the gender of Bachelor’s level chemists indicates that women and men are graduating at nearly equal numbers since 2001. Therefore, the Division has removed gender as criteria for a second nomination for this award.

Nominator (Your) Information

Is this your institutions First or Second Nomination?*

Nominator First Name*

Nominator Last Name*

Nominator's Email*

This is the email address that will receive the PDFs within 24 hours.

Nominator's Phone*

Which best describes your role in the nomination process for your department:*

If other is selected, please explain in the text box provided

URL to your Department Homepage*

Country*

Please indicate the country where your instution is located.

Certificate information

Be sure to double check spelling, capitalization, and punctuation. Student and University names will appear EXACTLY as you enter them.

Name of College or University, exactly as it should appear on the certificate*

Student's name exactly as it should appear on the certificate*

Student's Email*

We would like this for our records, at this time we do not have plans to contact the student about this award.

I certify that my college/university will only give the appropriate number of awards per academic year and that the student named above meets my college/university's criteria for the award.*

I Agree

Name

This field is for validation purposes and should be left unchanged.