2024 Annual Awards Nomination Form Nominee Information Name * Name First First Last Last Title * Email * Phone * Company/Organization * School * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country What Award Are You Nominating For? * STEM Achievement Award – Dr. Theodore S. Sergi K-12 Educator of the Year STEM Achievement Award – Student STEM Achievement Award – Higher Education STEM Achievement Award – Innovator STEM Achievement Award – Organization (Non-profit) STEM Achievement Award - Industry Question 1: Describe the nominee’s achievements in her STEM field. Please keep your response to under 500 words. * 0 of 500 max words Question 2: How does the nominee’s work open STEM and STEM career possibilities to diverse audiences? Please keep your response to under 500 words. * 0 of 500 max words Question 3: Describe the nominee’s efforts to mentor and support girls and/or women within her institution. Please keep your response to under 500 words. * 0 of 500 max words Question 4: If the nominee is an academic (faculty or researcher at a college or university), describe the nominee’s efforts to mentor and support girls and/or women independent of her institution. Please keep your response to under 500 words. * 0 of 500 max words Question 5: Please provide two letters of recommendation for this award. * 0 of 500 max words Question 1: Describe the audience that benefits from this student’s work in STEM? * 0 of 500 max words Question 2: Describe how this student has gone above and beyond her required classwork to benefit their community? * 0 of 500 max words Question 3: What else would you like us to know about this student? * 0 of 500 max words Question 1: Briefly summarize the individual’s involvement in STEM and STEM education, including the population they reach through their efforts. * 0 of 500 max words Question 2: How does the individual’s work open STEM and STEM career possibilities to diverse audiences? * 0 of 500 max words Question 3: What else should we know about this individual’s STEM mission driven efforts? * 0 of 500 max words This award recognizes and celebrates a girl in grades 9-12, who has shown curiosity, achievement and/or leadership in one or more STEM fields. This could be through promoting STEM education in the school or community, or through the creation and development of a novel product or technology tool. Examples of creative student projects or activities that demonstrate STEM curiosity and achievement are diverse and wide-ranging, and may include the following: Organizing and promoting an interactive community display on climate change at the local library. Mentoring/tutoring younger students in STEM subjects, and acting as an inspiring role model. Planning and coordinating a far-reaching school or community book read and discussion that explores our changing world through science. Writing guest editorials for news outlets from a student perspective on compelling and timely STEM issues. Using robotic technology to develop adaptive tools for disabled children. Question 1: Describe the audience that benefits from this student’s work? * 0 of 200 max words Question 2: Describe how this student has gone above and beyond her required classwork to benefit their community? * 0 of 200 max words Question 3: What else would you like us to know about this student? * 0 of 200 max words Question 1: Briefly summarize the individual’s involvement in STEM and STEM education, including the population they reach through their efforts. * 0 of 500 max words Question 2: How does the individual’s work open STEM and STEM career possibilities to diverse audiences? * 0 of 500 max words Question 3: What else should we know about this individual’s STEM mission driven efforts? * 0 of 500 max words Question 1: Briefly summarize the organization’s involvement in STEM and STEM education, including the population they reach through their efforts. * 0 of 500 max words Question 2: How does the organization’s work open STEM and STEM career possibilities to diverse audiences? * 0 of 500 max words Question 3: Describe how this organization’s work intersects with the broader STEM Education ecosystem. * 0 of 500 max words Question 1: Briefly summarize the company's involvement in STEM and STEM education, including the population they reach through their efforts. * 0 of 500 max words Question 2: How does the company's work open STEM and STEM career possibilities to diverse audiences? * 0 of 500 max words Question 3: What else should we know about this company's STEM mission driven efforts? * 0 of 500 max words Question 1: Briefly summarize the individual's involvement in STEM and STEM education, including the population they reach through their efforts. * 0 of 500 max words Question 2: How does the individual's work open STEM and STEM career possibilities to diverse audiences? * 0 of 500 max words Question 3: What else should we know about this individual's STEM mission driven efforts? * 0 of 500 max words Nominator Information Name of Nominator * Name of Nominator First First Last Last Title * Company / Organization / School * Email * Phone * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country If you are human, leave this field blank. 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