AIHA Nomination for 2016 Fellow Award
The Fellow Award was established to recognize members who have made significant contributions to
the practice of industrial hygiene and/or related disciplines that support the protection of worker health
and/or related disciplines such as, but not limited to, toxicology, occupational medicine, and health
physics. The number of Fellows is limited to not more than five percent of the membership.
Instructions:
All nominations for the Fellow Award of the AIHA shall be submitted using this nomination form.
Applications that are incomplete will not be considered for the award. Please complete the application
in as complete and concise a manner as possible. Applications that do not provide sufficient
information on the nominee cannot be adequately evaluated, which will diminish the probability of
nomination success. Please read and follow directions and attach all required supporting
documentation. Do not submit copies of articles, papers, books, etc. Completed nomination forms and
supporting documentation should be submitted to Judy Keithline by email to keithline@aiha.org or by
mail to 3141 Fairview Park Drive, Suite 777, Falls Church, Virginia 22042.
Each committee, local section, special interest group, and other formal AIHA entity may nominate, each
year, one individual for the Fellow Award. At large nominations will also be accepted, with the
exception that individuals may not self-nominate. The deadline for submissions is December 31, 2015.
All nominations will be evaluated by the Awards Committee and recommendations made to the AIHA
Board of Directors for approval.
1) Nominee Name:
Name:
Current Title:
Address:
Phone:
2) Nominated by:
Name of Local Section, Committee or SIG:
Contact:
Phone:
3) Qualifying Criteria
Please verify that the nominee meets each of the following minimum qualifying criteria by circling yes
or no.
American Industrial Hygiene Association 3141 Fairview Park Drive, Suite 777, Fall Church, VA 22042 USA
main +1 703-849-8888 fax +1 703-207-3561
AIHA member in good standing.
 Yes
 No
AIHA membership classification is Full.
 Yes
 No
Fifteen years of continuous membership in AIHA.
 Yes
 No
Certified in respective practice field.*
 Yes
 No
*If not certified, please provide an explanation for why the person is not certified in the
statement of qualification.
4) Statement of Qualification
Attach a brief (250 words maximum) statement about the nominee which includes a summary of the
nominee’s qualifications and an explanation of why the nominee is worthy of Fellow status.
5) Curriculum Vitae or Resume
Attach a curriculum vitae or resume of the nominee.
6) Recognized contribution to the Field of Industrial Hygiene
Recognized contribution is evidenced by solid contributions in at least three of the following areas.
For the nominee to be considered, a detailed summary of the nominee’s achievements in each of the
areas must be attached. When required, please include supporting documentation. Be very clear about
what achievements the nominee has in the areas chosen.
a. Original research or invention, demonstrated by the publication of papers in refereed journals.
(Some consideration will be given to articles in trade journals.) The nominee must be the
principal or the secondary author.
b. Work in policy areas which may include corporate, federal, state and local activities as well as
standards development and advocacy.
c. Technical, scientific, or management leadership in industrial hygiene.
d. Exemplary contributions to improving education in industrial hygiene. Contributions to education
include textbook authorship, editorships for IH compendia (e.g., Patty’s), teaching PDCs and
evaluations from those PDCs, giving short courses, development of training and teaching tools,
etc.
e. Direct contribution to AIHA by serving as an officer, in committee work, or conference planning.
7) Please indicate in which of the three areas (at least three) listed above the
nominee has made recognized contributions.
Under each area, note where the substantiating documentation can be found in the materials
presented with the nomination. For example:
Original research or invention - see pages 10-12 of Curriculum Vitae.
American Industrial Hygiene Association 3141 Fairview Park Drive, Suite 777, Fall Church, VA 22042 USA
main +1 703-849-8888 fax +1 703-207-3561
Exemplary Contributions to improving education in industrial hygiene - see student evaluations and
peer reviews attached.
Direct Contribution to AIHA by serving on a committee - see page 13 of Curriculum Vitae.
8) News Releases
AIHA’s communications office will generate a news release announcing the names of the members who
have been designated as Fellows. This release will be distributed to the appropriate media contacts at
each Fellow’s local news outlets and will also be made available on AIHA’s online press room and social
media channels.
Please submit this form to:
Judy Keithline at keithline@aiha.org or by mail to AIHA, 3141 Fairview Park Drive, Suite 777, Falls
Church, VA 22042. The deadline for submissions is December 31, 2015.
Questions? Please call Judy at 703-846-0702. Thank you.
American Industrial Hygiene Association 3141 Fairview Park Drive, Suite 777, Fall Church, VA 22042 USA
main +1 703-849-8888 fax +1 703-207-3561