Women in the Sciences & Engineering Institute

WISE Recognition Awards Nomination Form

All nominations and supporting documentation are due by 5:00 p.m. on December 15, 2009

NOTE: Data entered into this form is sent as an email message. Applicant's contact information will be kept private.( * = Required information )

Part I: On-Line Application

Section I: Nominator Information

Name of Nominator:*

Nominator PSU ID #:*

(replace 9 digit number with your PSU ID#; not SSN)

Nominator E-mail:*

Section II: Nominee Information

Please select the
Category of your
Nominee:*

Faculty Staff/Technical Service Undergraduate Student
Graduate Student

Is Nominee aware of nomination? :*

Yes No

Name of Nominee:*

Nominee Job Title/Rank/Student:*

Nominee Administrative/
Academic Unit/College:*

Nominee Department/Work Unit/Major:*

Nominee E-mail:*

Nominee Local or University Phone:*

Upon completion of all required fields for Part I above, please click the submit button to be directed to
Part II: Supporting Documentation Check List.