<p> NRC Research Associateship Programs</p><p>INSTRUCTIONS Page 1 of 4 Research Adviser Nomination Form</p><p>We ask for specific information on this form to help us determine your qualifications as an Adviser to our program. You may attach a curriculum vitae, but we require this completed form for our files to ensure we obtain all information required for our database.</p><p>Some important facts you should be aware of before completing this form:</p><p> For Adviser nominees who are not federal employees, a "Laboratory Assurance Statement" must accompany the "Nomination Form."</p><p> We cannot process this form without the proper authorization from your Laboratory Program Representative. This is the person we consider our primary point of contact at your Laboratory.</p><p> We rely on the Laboratory Program Representative to place the Research Opportunity in the appropriate Center, Division or Institute. </p><p> Your Research Opportunity title should be descriptive, not merely a department name.</p><p> Your Research Opportunity should be written in complete sentences.</p><p> To assist us in assigning panels, it is extremely important to mark the appropriate discipline into which your research falls.</p><p> We require keywords (maximum of 10) assigned to your Research Opportunity. Prospective applicants will use these keywords to search the Research Opportunities on the website.</p><p>Please include your current phone, and e-mail.</p><p>If you have any questions concerning this form, please contact Marla Allentuck at (202) 334-3637 or [email protected] Rev. 07/2015 OFFICE USE ID #______Panel______PO______Date______NRC Research Associateship Programs RESEARCH ADVISER NOMINATION www.nas.edu/rap Print Layout View Page 2 of 4 Date (Month Day, Year—e.g., May 1, 2015) Agency Laboratory/Center Division or Institute Select Participating Agency</p><p>Last Name of Nominated Research Adviser First Name Middle </p><p>Work Mailing Address Work Phone</p><p>Address continued or other Phone</p><p>City, State Zip E-mail , </p><p>CURRENT POSITION Title GS Grade/Military Rank Check if Nominee is NOT a Federal Employee and Attach Laboratory Assurance Statement Division / Department Branch Section</p><p>EDUCATION / TRAINING Dates Full Name of College or University Degree Year Field Year to Year</p><p> to </p><p> to </p><p> to Academic Honors</p><p>PROFESSIONAL POSITIONS Dates Position Employer Year to Year to to to Professional Societies and Affiliations (enter in this space or submit attachment)</p><p>Teaching Experience (enter in this space or submit attachment)</p><p>Awards and Inventions (enter in this space or submit attachment)</p><p>OFFICE USE PCD______RESEARCH ADVISER RO______</p><p>NOMINATION PUBLICATIONS Page 3 of 4</p><p>Show a separate listing by the following categories: (1) no more than 20 publications in peer-reviewed journals or those that have appeared within the last ten years. List only journal articles that have appeared, and give complete citations. (2) books or book chapters, and (3) patents. Presentations at scientific and technical meetings, abstracts, and papers appearing in a Proceeding should be listed separately. The electronic field below is “unlimited,” so it will expand to additional pages if entering or pasting more than a single page of publications. If you think those pages should be identified as pg. 2b, 2c, etc., you may enter that also in the electronic field, or you may handwrite/type it on top of the page(s) when you print out for signature. </p><p>OFFICE USE PCD______RESEARCH ADVISER RO______</p><p>NOMINATION PROPOSED RESEARCH OPPORTUNITIES Page 4 of 4 Last Name of Nominated Research Adviser First Name Middle </p><p>Full Name(s) of Additional Advisers(s) for this Opportunity</p><p>Agency Laboratory/Center Division or Institute Select Participating agency</p><p>Title of the opportunity as you wish it to appear on the NRC Research Associateship Programs (RAP) website</p><p>Full text of the opportunity as you wish it to appear on the NRC Research Associateship Programs (RAP) website (typed, complete sentences, double spaced)</p><p>Include no more than three literature references that have appeared within the last five years. Use only references to publications in journals or books (both electronic and print). Do not include conference proceedings or references that are “in press.”</p><p>Check one of the following general disciplines into which this research opportunity most appropriately falls:</p><p>Chemistry Earth Sciences Engineering Life Sciences Mathematics Physical Sciences Other</p><p>Keywords</p><p>Maximum of 9</p><p>Laboratory Program Representative or other Agency-Authorized Signature Date</p><p>A Research Opportunity cannot be posted to the RAP website without approval of the Agency and the Fellowships Office.</p><p>PLEASE SCAN THIS FORM TO PDF AND SEND VIA E-MAIL TO: [email protected] Rev. 07/2015</p>