2016 CGS/ProQuest Distinguished Dissertation Award
NOMINATION FORM
Award Category (select one):
Eligible Departments for the Social Sciences award
 Agricultural Economics
 Curriculum and Instruction
 Economics
 Family Studies and Human Services
 Geography
 Hospitality Management
 Psychological Sciences
 Security Studies (interdisciplinary program)
 Sociology, Anthropology, and Social Work
Eligible Departments for the Engineering, Math, and Physical
Sciences award
 Biological and Agricultural Engineering
 Chemical Engineering
 Chemistry
 Civil Engineering
 Computer Science
 Electrical and Computer Engineering
 Industrial and Manufacturing Systems Engineering
 Mathematics
 Mechanical and Nuclear Engineering
 Physics
CONTACT INFORMATION
Nominee Name:
Mailing address (street, city, state, zip code):
Telephone number:
Email address:
PROFESSIONAL BACKGROUND
Current Employer:
Position Title:
CERTIFICATION OF INSTITUTION
Degree Program:
Name of major professor:
Title of Dissertation:
Date of Completion of All Degree Requirements (month/day/year):
This is the date when all requirements have been completed/submitted (i.e., ballots, ETDR, Proquest, etc.)
Date of Degree Award (actual or expected) (month/day/year):
This is the official date of graduation, which is the last day of the term in which the nominee graduated or
anticipates graduating.
Is Dissertation Multi- or Interdisciplinay?
If yes, which fields are included?