Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
1
` Application for Fellow of AOAC INTERNATIONAL
TO: Chair, Fellows Award Committee AOAC INTERNATIONAL
2275 Research Blvd, Suite 300 Rockville, MD 20850
I hereby submit the following application in support of my nomination for the Fellow of AOAC INTERNATIONAL Award.
1. Name of Candidate: __________________________________________________________________________________(FIRST) (MIDDLE) (LAST)
2. Home Address:
_______________________________________________________________________________________________
(STREET ADDRESS)
_______________________________________________________________________________________________
(CITY) (STATE/PROVINCE) (ZIP/POSTAL CODE) (COUNTRY)
_______________________________________________________________________________________________ (PHONE) (FAX) (E-MAIL)
3. Business Address:
_________________________________________________________________________________________________
(AGENCY OR FIRM)
________________________________________________________________________________________________
(STREET ADDRESS)
________________________________________________________________________________________________ (CITY) (STATE/PROVINCE) (ZIP/POSTAL CODE) (COUNTRY)
_________________________________________________________________________________________________ (PHONE) (FAX) (E-MAIL)
2
ACTIVITY
1. AOAC STANDARDS DEVELOPMENT
Activity or Volunteer Role
Have you ever served as a Participant of a Stakeholder Panel/Working Group? Yes or No? If yes, please list the committee(s) and all that apply
From (Year)
To (Year)
Achievement/ Output (i.e. Standard Method
Performance Requirements (SMPRs®)
Stakeholder Panel Chair
Stakeholder Panel Member
Working Group Chair
Working Group Member
3
2. AOAC CONFORMITY ASSESSMENT AND METHODS APPROVAL
Activity or Volunteer Role
Have you served on an Expert Review Panel or participated in methods approval? Yes or No? If yes, please indicate which role(s)
From (Year)
To (Year)
Achievement/ Output (i.e. methods reviewed/adopted as Official First Action)
Expert Review Panel Chair
Expert Review Panel Member
AOAC Expert (formerly “General Referee”)
Safety Advisor
Statistical Advisor
Method Author/Submitter
Method Volunteer (Method Committee Member, Topic Advisor, Study Director, Collaborator, Other)
4
3. AOAC PUBLICATIONS
Activity or Volunteer Role
Have you ever participated/volunteered or been a peer reviewer for the Journal of AOAC INTERNATIONAL? Yes or No? If yes, please indicate which role(s)
From (Year)
To (Year)
Achievement/ Output
Journal Section Editor
Journal Peer Reviewer
Special Guest Editor
Journal Paper Author/ Co-Author
ILM Article Author or Contributor
5
4. PROGRAMMING, AWARDS, AND EDUCATION
Activity or Volunteer Role
Have you ever served in a volunteer capacity or received any awards from AOAC INTERNATIONAL? Yes or No? If yes, please indicate which role(s)
From (Year)
To (Year)
Achievement/ Output
Technical Programming Council (TPC) Chair
Technical Programming Council (TPC) Member
Symposium Organizer / Chair
Symposium / Workshop Presenter
Workshop/Training Chair
Exhibitor
Poster Presenter
Keynote Speaker
AOAC Award Recipient (Wiley, Fellow, Special /50yr Member)
OMB Award Recipient (List all that apply) (i.e. Technical Service Award. ERP Award)
Award Recipient (Member Recognition: 5, 10, 25yr, etc.)
Award Recipient (Other – TDRM, Poster)
6
5. CURRENT AOAC VOLUNTEER BOARDS
Activity or Volunteer Role
Have you ever served on any AOAC INTERNATIONAL Official Board(s)? Yes or No? If yes, please indicate which role(s)
From (Year)
To (Year)
Achievement/ Output
AOAC INTERNATIONAL Board of Directors Officer
AOAC INTERNATIONAL Board of Directors Member at Large
AOAC Research Institute (RI) Board of Directors Officer
AOAC Research Institute (RI) Board of Directors Member at Large
Official Methods Board (OMB) Chair/Vice Chair
Official Methods Board (OMB) Member
Editorial Board Chair
Editorial Board Member
7
6. SPECIAL AND TECHNICAL COMMITTEES AND DIVISIONS
Activity or Volunteer Role
Have you ever served on any AOAC Special and Technical Committees, Divisions, or Task Force(s)? Yes or No? If yes, please indicate which role(s)
From (Year)
To (Year)
Achievement/ Output
LPTP Advisory Committee
Technical Division on Laboratory Management (TDLM)
ALAC Committee
Technical Division on Reference Materials (TDRM)
Tellers Committee
Harvey W. Wiley Committee
Committee on Fellows
Task Force(s)
8
7. AOAC MEMBERSHIP, SECTIONS, AND ANALYTICAL COMMUNITIES
Activity or Volunteer Role
Have you ever served in a leadership capacity or volunteered on any Sections, Membership or Analytical Communities? Yes or No? If yes, please indicate which role(s)
From (Year)
To (Year)
Achievement/ Output
Committee on Membership
Committee on Sections
Section – Executive Committee or Officer
Section – Member at Large
Section – Meeting Speaker/Presenter
Community – Chair/Subgroup Chair (e.g. Chemical Contaminants)
Community Member
Community – Meeting Speaker/Presenter
8. AOAC ANNUAL MEETING/OTHER
Activity or Volunteer Role
Have you ever attended an AOAC Annual Meeting? Yes or No? If yes, please indicate which role(s)
From (Year)
To (Year)
Achievement/ Output
AOAC Mid-year Meeting
AOAC Annual Meeting and Exposition
9
9. OTHER CONTRIBUTIONS
Please list any other contributions that you have made to AOAC. (Specify the nature of such and year)
(e.g. add description from other contributions).
(Attach additional sheets, if needed, for any above item)
Submitted by:
____________________________________________________________________________________________________
(CANDIDATE SIGNATURE) (DATE)
10
Application Received:
For AOAC office use only:
Nominated By:
Revised by AOAC BODs 12/2016
Click the "Submit" button to send electronically to AOAC INTERNATIONAL or you may print the form and send it via fax to (301)924-7089.
If you have questions regarding this application, please contact May Rose Jones at [email protected]