SOCIETY FOR CONSERVATION BIOLOGY



Society for Conservation Biology 2019 Service Awards Nomination Form

Submit nominations by 18 January 2018 to the Awards Committee at awards@.

Put the name of the nominee and the award type (i.e. Distinguished Service; Early Career Conservationist, Beacon, LaRoe) in the subject line of your email (i.e. Juan Pérez – Early Career Conservationist Award Nomination).

If you have questions, please contact Awards Committee Chair Eduardo Gallo Cajiao at awards@.

Please contact the Awards Committee Chair if you have a potentially deserving nominee but, due to timing, the deadline may not be strictly met. SCB understands the diversity of cultures and calendars around the world, as well as the type of work conservationists get involved with, which can include extended periods in the field.

In this Application

Part 1: Information of the individual / institution being nominated for an SCB Service Award

Part 2: Information of the individual making the nomination

Part 3: Supporting Letters

Nominee Information

1) Is this a self-nomination or are you nominating someone else? (check ONE only)

• Self

• Nominating someone else

2) Are you nominating for (check ONE only):

• Individual

• Institution*

*If you are nominating an institution for a Distinguished Service Award, please provide the name of the institution and the name and contact information of the individual who should accept the award on behalf of the institution e.g., the name of the organization's president or the organization’s founder:

Name of Institution:

Location (primary country) of Institution:

Website of Institution:

Name of Individual to Accept Award (from institution):

Title:

Email:

3) Please indicate with an “X” the award type you are nominating for (refer to the SCB 2019 Service Awards page for more information on each award type).

• Distinguished Service Award

• LaRoe Award

• Early Career Conservationist Award

• Conservation Beacon Award

4) Contact information of nominee, if not an institution, otherwise include the contact details of a representative from the corresponding institution.

Name:

Address:

Telephone:

Email:

Country of Origin:

Gender identity:

5) How would you categorize the geographical scale of the achievement of the Nominee? You may check more than one category.

___ Local (restricted area, district, or zone within a country)

___ National (across more areas / fields within a country)

___ Regional (e.g. Sub-Saharan Africa)

___ International (more than one country)

___ Global (influence across more than one broad region)

6) Please describe the “discipline” or the “type of work” of the nominee that contributes to conservation through practice, policy, education, outreach, etc (20 words maximum).

7) Nominee's Achievements (400 words maximum)

This description will be the principle source of information used in the selection process and voting. It should provide a brief resume of the individual, or description of the mission and type of institution, and clearly explain the achievements that deserve recognition. If you are nominating for the LaRoe Award please cite government service and impact on policy.

8) Summary Statement (25 words maximum)

This statement should indicate the core justification for the award. It will be used on the certificate if the nominee receives an award. For example, "For extraordinary contributions to the conservation of xxxx's biodiversity through leadership in xxx."

Information of Individual Making the Nomination

1) Please provide your full contact information below:

Name:

Institution:

Address:

E-mail:

Telephone:

2) Supporting letters:

Please list here the names of people providing letters of support (a minimum of two letters are needed), and either paste the letters within this document, or include as additional documents (e.g., pdfs) with your email submission.

We suggest that letters address the individual’s contributions to:

- On-the-ground conservation

- Research and publications

- Teaching and mentoring

- Public outreach

- Policy impact

Supporting Letter 1:

Name:

Institution:

E-mail:

Supporting Letter 2:

Name:

Address:

E-mail:

Supporting Letter 3:

Name:

Address:

E-mail:

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