The  Distinguished  Scientific  Achievement  Award  is  a  prestigious  award  honoring  a  scientist  who  has  made  a  major  contribution  to  liver  disease  research  in  basic  science  or  in  its  application  towards  the  prevention,  treatment  or  cure  of  

liver  disease.  

Nominee  Name:_________________________________________  Organization/Institution  of  Nominee:___________________________________  

Mailing  Address  and  Contact  Information  for  Nominee  

Street:        __________________________________________________________________  Street  2:  __________________________________________________________________  City:                  _______________________________  State:            _______________________________  Zip:                    _____________  Telephone:    ___________________            Email  Address:_________________________________  

This  nomination  is  being  submitted  by  (name):    __________________________________________  Organization/Institution  of  Individual  Submitting  this  Nomination:________________________________  

Mailing  Address  and  Contact  Information  for  the  Individual  Submitting  this  Nomination  

Street:        __________________________________________________________________  Street  2:  __________________________________________________________________  City:                  _______________________________  State:            _______________________________  Zip:                    _____________  Daytime  Telephone:    ___________________            Email  Address:_________________________________  

Attachments  Required:  

1. Letter  of  recommendation  -­‐  Attach  a  detailed  letter  of  no  more  than  two  pages,  on  why  you  think  this  personshould  receive  the  Distinguished  Scientific  Achievement  Award.

2. Nominee’s  full  Curriculum  Vitae

Previous  recipients  of  this  award  can  be  found  at  the  webpage  be  below:  http://www.liverfoundation.org/medical-professionals/alf-research-awards-program

To  submit  a  nomination,  fill  out  this  form  and  send  it  along  with  required  documents  via  email  to  Megan Glynn  at   MGlynn@liverfoundation.org  

For  further  information,  contact  Megan Glynn  at  646-737-9402  or  via  email:  MGlynn@liverfoundation.org  

Incomplete  nominations  and  late  nominations  will  not  be  accepted.