U.S. EPA Office of Research and Development

2007 Scientific and Technological Achievement Awards

NOMINATION FORM

GENERAL INFORMATION
Award Category:

Laboratory/Office mailing address:

Principal Author Contact:

Telephone Number:	E-mail Address:
Office Award Contact:

Telephone Number:	E-mail Address:
NOMINATION INFORMATION
Are multiple papers being submitted as one nomination?	YES	NO
If YES, provide additional information in the "Nominated Papers" section on page 3.
Please list the title of each nominated paper (up to three papers):
1.

2.

3.

Principal and Contributing Authors: (First, Initial, Last Name)

Are supplemental items attached?	YES	NO

If YES, please list items in "Supplemental Items" section on page 3.

ELIGIBILITY CHECKLIST - Please make certain that --

1. The nominated publication(s) has not been submitted to a previous STAA competition.

2. The nominated publication(s) was published after January 1, 2004.

3. The principal author was an EPA employee or a PHS employee assigned to EPA when the research was performed.

4. The eligible authors were EPA employees or PHS employees assigned to EPA when the research was performed.

5. The eligible authors contributed collectively a minimum of 50% toward the publication(s).

6. The eligible and non-eligible authors have each submitted a "Record of Agreement" e-mail to attest that credit has been correctly assigned.

Name:	Title:
Signature:	Date:
Name:	Title:
Signature:	Date:
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ELIGIBLE AUTHORS: PRINCIPAL & CONTRIBUTING	Total Percentage of Eligible Author

Effort (Must Be Whole Number):
Name:	% of Total Effort (Must Be Whole Number):
Professional Title:	Series, Grade:
E-mail Address:	Separation Date:
Address, if different from Laboratory/Office Address

Is a "Record of Percentage Agreement" E-mail attached? (Yes/No)
Name:	% of Total Effort (Must Be Whole Number):
Professional Title:	Series, Grade:
E-mail Address:	Separation Date:
Address, if different from Laboratory/Office Address

Is a "Record of Percentage Agreement" E-mail attached? (Yes/No)
Name:	% of Total Effort (Must Be Whole Number):
Professional Title:	Series, Grade:
E-mail Address:	Separation Date:
Address, if different from Laboratory/Office Address

Is a "Record of Percentage Agreement" E-mail attached? (Yes/No)
Name:	% of Total Effort (Must Be Whole Number):
Professional Title:	Series, Grade:
E-mail Address:	Separation Date:
Address, if different from Laboratory/Office Address

Is a "Record of Percentage Agreement" E-mail attached? (Yes/No)
INELIGIBLE AUTHORS	Total Percentage of Ineligible Author

Effort (Must Be Whole Number):
Name:	% of Total Effort (Must Be Whole Number):
E-mail Address:
Organization/Mailing Address:

Is a "Record of Percentage Agreement" E-mail attached? (Yes/No)
Name:	% of Total Effort (Must Be Whole Number):
E-mail Address:
Organization/Mailing Address:

Is a "Record of Percentage Agreement" E-mail attached? (Yes/No)
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NOMINATED PAPERS
Paper Title:

Publication Date:

Volume:	Number:	Pages:
Journal:

Immediacy Index:

Citation ½ Life:	Impact Factor:
Principal Author: (First Initial, Last Name)

Contributing Authors: (First Initial, Last Name)

Paper Title:

Publication Date:

Volume:	Number:	Pages:
Journal:

Immediacy Index:

Citation ½ Life:	Impact Factor:
Principal Author: (First Initial, Last Name)

Contributing Authors: (First Initial, Last Name)

Paper Title:

Publication Date:

Volume:	Number:	Pages:
Journal:

Immediacy Index:

Citation ½ Life:	Impact Factor:
Principal Author: (First Initial, Last Name)

Contributing Authors: (First Initial, Last Name)

SUPPLEMENTAL ITEMS

Please list each supplemental item (up to four) attached to this nomination:

1.

2.

3.

4.

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JUSTIFICATION
Please provide substantial evidence for each of the following:
1. Value and utility of the research, (e.g., innovation, transferability) and its relevance to EPA's mission:

2. If applicable, describe the relationship of this nomination to previous nominations with similar subjects and authors (NOTE: Please remember that papers nominated in any earlier STAA competition are not eligible for this year's competition.):
3. Evidence of recognition of the contribution from outside EPA:
4. An explanation of the nature of internal and external peer review (this is particularly important):

CITATION
Please propose an appropriate citation reflecting the value of the work to the Agency that will be printed on the award certificate for winning STAA nominations. Keep in mind that the word "for" will precede the citation on the actual certificate. Do NOT use the title of the paper and do NOT exceed 120 characters including spaces.
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