2008 LONG ISLAND SCIENCE CONGRESS

ROBERT NELSON SCHOLARSHIP AWARD

Nomination Form

Student Name: ________________________________________________

Project Title: __________________________________________________

Please respond to each of the following by circling the appropriate expression:

1. The nominee is an: _{_}11^th grader 12^th grader

2. Is the project a strictly individual project, not involving team effort? Yes No

3. Was the work on the project performed as part of a hospital, university or research facility project or protocol? Yes No

4. What degree of initiative do you attribute to the student: High Very High Average

5. What is the nominee's overall scholastic average?

96%-100% 91%-95% 86%-90% 81%-85%

6. How do you rate the nominee’s contributions as a school citizen?

Extra noteworthy Noteworthy Average

7. How do you rate the nominee’s community (other than school) contributions?

Extra noteworthy Noteworthy Average

8. Indicate science course(s) completed by the nominee by "C", and any in which the nominee is currently enrolled by "E".

___Biology ___Science Research ___AP Physics

___Chemistry ___AP Biology ___Other____________

___ Physics ___AP Chemistry ___Other____________

9. Does the nominee have science-related career goals? Yes No

10. Is a letter of recommendation written on the reverse side? Yes No

School:___________________________________________________________

Liaison’s name (please print below) Liaison’s signature (please sign below)