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` Application for Fellow of AOAC INTERNATIONAL

TO: Chair, Fellows Award Committee AOAC INTERNATIONAL

2275 Research Blvd, Suite 300 Rockville, MD 20850

I hereby submit the following application in support of my nomination for the Fellow of AOAC INTERNATIONAL Award.

1. Name of Candidate: __________________________________________________________________________________(FIRST) (MIDDLE) (LAST)

2. Home Address:

_______________________________________________________________________________________________

(STREET ADDRESS)

_______________________________________________________________________________________________

(CITY) (STATE/PROVINCE) (ZIP/POSTAL CODE) (COUNTRY)

_______________________________________________________________________________________________ (PHONE) (FAX) (E-MAIL)

3. Business Address:

_________________________________________________________________________________________________

(AGENCY OR FIRM)

________________________________________________________________________________________________

(STREET ADDRESS)

________________________________________________________________________________________________ (CITY) (STATE/PROVINCE) (ZIP/POSTAL CODE) (COUNTRY)

_________________________________________________________________________________________________ (PHONE) (FAX) (E-MAIL)

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ACTIVITY

1. AOAC STANDARDS DEVELOPMENT

Activity or Volunteer Role

Have you ever served as a Participant of a Stakeholder Panel/Working Group? Yes or No? If yes, please list the committee(s) and all that apply

From (Year)

To (Year)

Achievement/ Output (i.e. Standard Method

Performance Requirements (SMPRs®)

Stakeholder Panel Chair

Stakeholder Panel Member

Working Group Chair

Working Group Member

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2. AOAC CONFORMITY ASSESSMENT AND METHODS APPROVAL

Activity or Volunteer Role

Have you served on an Expert Review Panel or participated in methods approval? Yes or No? If yes, please indicate which role(s)

From (Year)

To (Year)

Achievement/ Output (i.e. methods reviewed/adopted as Official First Action)

Expert Review Panel Chair

Expert Review Panel Member

AOAC Expert (formerly “General Referee”)

Safety Advisor

Statistical Advisor

Method Author/Submitter

Method Volunteer (Method Committee Member, Topic Advisor, Study Director, Collaborator, Other)

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3. AOAC PUBLICATIONS

Activity or Volunteer Role

Have you ever participated/volunteered or been a peer reviewer for the Journal of AOAC INTERNATIONAL? Yes or No? If yes, please indicate which role(s)

From (Year)

To (Year)

Achievement/ Output

Journal Section Editor

Journal Peer Reviewer

Special Guest Editor

Journal Paper Author/ Co-Author

ILM Article Author or Contributor

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4. PROGRAMMING, AWARDS, AND EDUCATION

Activity or Volunteer Role

Have you ever served in a volunteer capacity or received any awards from AOAC INTERNATIONAL? Yes or No? If yes, please indicate which role(s)

From (Year)

To (Year)

Achievement/ Output

Technical Programming Council (TPC) Chair

Technical Programming Council (TPC) Member

Symposium Organizer / Chair

Symposium / Workshop Presenter

Workshop/Training Chair

Exhibitor

Poster Presenter

Keynote Speaker

AOAC Award Recipient (Wiley, Fellow, Special /50yr Member)

OMB Award Recipient (List all that apply) (i.e. Technical Service Award. ERP Award)

Award Recipient (Member Recognition: 5, 10, 25yr, etc.)

Award Recipient (Other – TDRM, Poster)

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5. CURRENT AOAC VOLUNTEER BOARDS

Activity or Volunteer Role

Have you ever served on any AOAC INTERNATIONAL Official Board(s)? Yes or No? If yes, please indicate which role(s)

From (Year)

To (Year)

Achievement/ Output

AOAC INTERNATIONAL Board of Directors Officer

AOAC INTERNATIONAL Board of Directors Member at Large

AOAC Research Institute (RI) Board of Directors Officer

AOAC Research Institute (RI) Board of Directors Member at Large

Official Methods Board (OMB) Chair/Vice Chair

Official Methods Board (OMB) Member

Editorial Board Chair

Editorial Board Member

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6. SPECIAL AND TECHNICAL COMMITTEES AND DIVISIONS

Activity or Volunteer Role

Have you ever served on any AOAC Special and Technical Committees, Divisions, or Task Force(s)? Yes or No? If yes, please indicate which role(s)

From (Year)

To (Year)

Achievement/ Output

LPTP Advisory Committee

Technical Division on Laboratory Management (TDLM)

ALAC Committee

Technical Division on Reference Materials (TDRM)

Tellers Committee

Harvey W. Wiley Committee

Committee on Fellows

Task Force(s)

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7. AOAC MEMBERSHIP, SECTIONS, AND ANALYTICAL COMMUNITIES

Activity or Volunteer Role

Have you ever served in a leadership capacity or volunteered on any Sections, Membership or Analytical Communities? Yes or No? If yes, please indicate which role(s)

From (Year)

To (Year)

Achievement/ Output

Committee on Membership

Committee on Sections

Section – Executive Committee or Officer

Section – Member at Large

Section – Meeting Speaker/Presenter

Community – Chair/Subgroup Chair (e.g. Chemical Contaminants)

Community Member

Community – Meeting Speaker/Presenter

8. AOAC ANNUAL MEETING/OTHER

Activity or Volunteer Role

Have you ever attended an AOAC Annual Meeting? Yes or No? If yes, please indicate which role(s)

From (Year)

To (Year)

Achievement/ Output

AOAC Mid-year Meeting

AOAC Annual Meeting and Exposition

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9. OTHER CONTRIBUTIONS

Please list any other contributions that you have made to AOAC. (Specify the nature of such and year)

(e.g. add description from other contributions).

(Attach additional sheets, if needed, for any above item)

Submitted by:

____________________________________________________________________________________________________

(CANDIDATE SIGNATURE) (DATE)

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Application Received:

For AOAC office use only:

Nominated By:

Revised by AOAC BODs 12/2016

Click the "Submit" button to send electronically to AOAC INTERNATIONAL or you may print the form and send it via fax to (301)924-7089.

If you have questions regarding this application, please contact May Rose Jones at mjones@aoac.org