Graduate Student Awards

Submitter First Name

Submitter Last Name

Submitter Phone

Submitter Email

Submitter Relationship to Nominee

SelfFaculty working with studentStaff working with studentStudent nominating another student

Nominee First Name

Nominee Last Name

Nominee's Graduate Program

Nominee's Expected Graduation Date

Type of Program in which Nominee is Enrolled

Master's DegreeDoctoral DegreeMD/PhD

Upload Nominee's Current CV

Upload Nominee's Penn State Graduate Transcript

Upload other supporting information (letters of recommendation, evaluations, award/recognition certificates, publications, etc.). Use "Add Another Document" to provide more information.

OVERVIEW STATEMENT

Describe why the nominee deserves an award. (Limit is 50 words.)

RESEARCH FUNDING

List any competitive research funding proposals for which the nominee submitted an application. Indicate funding sponsor, and whether the application was funded. Use "Add More Research Funding" to add more rows if needed.

Funding Sponsor

Amount

Funded?

YesNo

SCIENTIFIC PRESENTATIONS AT NATIONAL/INTERNATIONAL MEETINGS

Indicate if a) the meeting organizers specifically invited the nominee to present their work, b) it was an oral or poster presentation, c) the nominee was the first author, and d) if the nominee presented the work. Use "Add More Presentations" to add more rows if needed. Do not include Graduate Research Forum, Graduate Exhibition or other Penn State presentations. List meeting travel awards in the Academic and Research Honors section below.

PEER-REVIEWED PUBLICATIONS

List all peer-reviewed publications accepted, in press or published that are derived from the nominee's work at the College of Medicine. Use "Add More Publications" to add rows as needed. Do not include works in preparation or submitted.

Patent #

Patent Title

Co-Inventors

MERIT-BASED ACADEMIC AND RESEARCH HONORS AND AWARDS

List any merit-based academic or research recognition awards or honors (but not funded grants) that the nominee has received while in graduate school at Penn State College of Medicine. List awarding agency. Do not include previous alumni scholarships. Use "Add More Awards" to add rows as needed.

Award Title

Awarding Agency

Award Year

ORGANIZATIONS AND LEADERSHIP ROLES SUPPORTING PROFESSIONAL DEVELOPMENT

List organizations that support professional development in which the nominee had sustained participation while in graduate school at the College of Medicine, with dates of participation. Also list any leadership positions the nominee had in these organizations, along with the dates in that role. Do not include professional societies in which the nominee pays dues but has no active participation (e.g. AAAS) or honor societies that do not have regular activities. Acceptable examples include GSA, GWIS, etc. Organizations with a non-scientific focus should go in the next section. Use "Add More Organizations" to add rows as needed.

Group Name

Dates of Involvement

Organization Type

InternalExternal

Leadership Role (if any)

Dates of Leadership

OTHER ORGANIZATIONS AND VOLUNTEER WORK

List other organizations and volunteer work the nominee has done while in graduate school at the College of Medicine, with dates of participation. Indicate whether it was a one-time opportunity or sustained work and whether the nominee's professional expertise was used. Do not include volunteer work for organizations that support professional development listed in the previous section. Use "Add More Organizations" to add rows as needed.

PLEASE READ AND INITIAL BELOW:

I affirm that the information I provided on this application form and any additional materials that I submit related to this application are complete, accurate and true to the best of my knowledge.

Pursuant to the Family Educational Rights and Privacy Act of 1974 (FERPA), as amended, I hereby authorize The Pennsylvania State University to release the scholarship application that I provide, as well as other official and unofficial Penn State information regarding my academic progress and status, to the Scholarship Review Committee for the purpose of providing committee members with information concerning my eligibility as a scholarship recipient.

I also understand that furnishing false information may result in disciplinary action pursuant to The Pennsylvania State University Code of Student Conduct.