Robert Zalosh Award for Hydrogen Safety Excellence Nomination Form

(Form must be typewritten in English)

SUBMISSION DEADLINE: October 31, 2024

NOMINATOR

Name of Nominator*

Please enter YOUR full name

Institution/Affiliation*

Please enter YOUR institution/affiliation name

Telephone Number

Please add YOUR telephone number. (Numbers only. No Letters)

E-mail*

Please enter YOUR email

NOMINEE

Name of Nominee*

(This can be an individual, project, or organization.)

Institution/Affiliation*

Telephone Number

E-mail*

Street Address*

Nomination Category*

Please select the category for this nomination. See Categories here

Select or enter value

PROPOSED CITATION*

(A brief summary of the candidate’s specific, documented contributions. 40 words max)

BRIEF OVERVIEW OF INDIVIDUAL, PROJECT OR ORGANIZATION

(If a project states the location of the project)

HOW THE NOMINEE ADVANCES SAFETY CULTURE AND ENSURES SAFE OUTCOMES*

HOW THE NOMINEE BENEFITS/ADDS VALUE TO THE HYDROGEN INDUSTRY*

WHY THE NOMINEE DESERVES THIS EXCELLENCE AWARD*

HOW THE NOMINEE CONTRIBUTES TO BEST PRACTICES AND LESSONS LEARNED*

LETTERS OF SUPPORT

Please submit at least TWO Letters of Support below and include the name of the letter writer at the top of each letter uploaded.

ADDITIONAL INFORMATION*

(Other supporting information that demonstrates the nominee’s accomplishments and commitment to hydrogen safety can be attached at the end of the submittal.)

DOES THE NOMINEE MEET THE SPIRIT AND INTENT OF THE AIChE CODE OF ETHICS?*

Please see the AIChE CODE OF ETHICS here

Select or enter value

Additional supporting information may be attached

(No more than three pages, no less than 11-point font (Calibri, Arial, or Times New Roman).

File Upload*

You can add up to six attachments in total. PDF ONLY!

Drag and drop files here or

CERTIFICATION:*

By clicking this checkbox, you confirm the following: To the best of my knowledge, I attest that the information provided is true and factual and that the awardee has demonstrated a significant commitment to hydrogen safety. I am not the nominee, part of the nominee’s project/organization, or a family member.

Signature*

(Please add your full legal name which we will use as a form of signature.)

Date*

Send me a copy of my responses

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