**2005 FDA Scientific Achievement Awards**

The FDA Scientific Achievement Awards recognize FDA scientists who have
made outstanding contributions to the agency. There are **seven** award
categories for 2005.

Nominations, both individual and group, will be considered for
"**Excellence in Analytical Science**," "**Excellence in Laboratory
Science**," "**Excellence in Review Science**," **"Outstanding Junior
Investigator," "Outstanding Support Scientist", and "Outstanding New
Reviewer."** In addition, group nominations will be considered for an
"**Outstanding Intercenter Scientific Collaboration."** All FDA
scientists who have demonstrated exemplary performance in their assigned
scientific duties are eligible. The work for which the individual or
group is nominated must have been initiated and completed while the
nominee was employed by FDA. *The nomination should be for a completed
body of work.*

For the first six categories, the Scientific Achievement Awards
selection process will be two-phases. In the first phase, Center and
Office of Regulatory Affairs (ORA) Scientific Achievement Award
recipients will be selected by the respective center and ORA selection
committees and forwarded to the Office of Science and Health
Coordination.

In the second phase, the FDA Scientific Achievement Awards Selection
Committee and the FDA Science Board will review the Center/ORA level
Scientific Achievement Award winners, that were forwarded to the Office
of Science and Health Coordination as nominees for the FDA Scientific
Achievement Awards. Recipients of the FDA Scientific Achievement Awards
in these categories will receive a \$2000 cash award and a plaque.

Group nominations for the **2005** **Outstanding Intercenter Scientific
Collaboration** **Award** should be sent directly to Donna L. Mentch,
OSHC, by **November 29, 2004**, for review by the FDA Scientific
Achievement Award Selection Committee. The group selected as winner of
this award will receive a \$5,000.00 cash award and plaque.

Award nominations, which may be made by any employee, including the
nominee or the nominee's immediate supervisor, will consist of a
completed Award Nomination Form, a description of scientific
achievement, a curriculum vitae, and two completed award reference
forms. These documents must be submitted to the chairperson of your
Center or ORA Scientific Achievement Awards selection committee by
**November 5, 2004.** After the review of the Center/ORA awards
selection committee the Chairperson will forward the Center/ORA
nomination packages to Donna L. Mentch, OSHC by **November 29, 2004**.

**2005 FDA Scientific Achievement Awards**

### Guidance for Determining Appropriate Awards Category

**Excellence in Analytical Science**

Analytical science includes, but is not limited to, development and use
of new and/or uniquely applied methods of analysis, e.g., analytical
methods development, device failure analysis, drug interaction analysis,
epidemiological research, predictive modeling, methods correlation and
data analysis, statistical method development, etc.

**Excellence in Laboratory Science**

Laboratory science includes, but is not limited to, research to
investigate biological, chemical, or pharmacological phenomena, e.g.,
mechanistic studies to assess carcinogenic risk of specific chemicals,
mechanisms of disease pathogenesis, interaction of immune function and
drug metabolism, study of emerging pathogens, toxicity profile
identification, etc.

**Excellence in Review Science**

Review science includes, but is not limited to, new and/or uniquely
applied approaches to regulatory decision-making and ability to
interpret scientific information submitted to the agency, e.g.,
application of scientific expertise to the review process, national and
international standards development and harmonization, development of
regulatory policies and guidance, etc.

**Outstanding Intercenter Scientific Collaboration**

This category recognizes those individuals involved in an outstanding
**intercenter/ORA** collaborative effort that makes a significant
contribution to the development and/or application of scientific
information for solving problems related to the agency's public health
mission. This award recognizes that collaborative efforts were required
to achieve the public health objective.

#### Outstanding Junior Investigator Award

This category recognizes a scientist who has made significant
contributions to the mission of the FDA in the field of either basic or
applied research or in regulatory review science. To be considered, the
individual must be no more than 5 years past attaining their
post-graduate degree. Accomplishments should be judged by the same
general standards as those for the other science awards.

#### Outstanding Support Scientist Award

This category recognizes the outstanding achievements of a support
scientist who, under the direction of the principal investigator, lab
director or supervisor, has been highly instrumental in the
accomplishments and successes of the lab or regulatory review office.
This nominee must demonstrate a high degree of dedication and assistance
in the conception, development, technical aspects, and implementation of
laboratory or regulatory review projects.

**2005 FDA Scientific Achievement Awards**

**Outstanding New Reviewer Award**

This FDA award recognizes new reviewers who have demonstrated an
extraordinary grasp of the public health objectives of the Agency's
review process and through their efforts have impacted or contributed to
a significant regulatory decision of their review unit.

Eligibility and Section Criteria: Reviewer's that have less than three
years of review experience (at FDA) and the nomination for the award
should be within six years following attaining their post-graduate or
terminal degree.

-   Achievements that may be used to support a nomination may include:

-   Independent review of a complex application

-   Presentation of the primary review of a complex matter to an
    Advisory Committee,

-   Original scientific contribution that impacts a regulatory decision

-   Publication or invited presentation of review related research

-   Significant contribution to the development of a new guidance
    document (particularly a regulatory science guidance as opposed to a
    procedural guidance) or improvement of a current guidance document

**2005 FDA SCIENTIFIC ACHIEVEMENT AWARDS**

**Guidance for Sponsors**

Nominations for FDA Scientific Achievement Awards are solicited in seven
categories:

Excellence in Analytical Science

Excellence in Laboratory Science

Excellence in Review Science

Outstanding Intercenter Scientific Collaboration

Outstanding Junior Investigator

Outstanding Support Scientist

Outstanding New Reviewer

*See pages 2 & 3 in determining appropriate awards category.*

These awards are granted to individuals or groups whose work has made
significant contributions to the agency in a particular area of study.
FDA scientists of any tenure, grade, center or professional affiliation
may be nominated.

To be eligible for an award, the nominee (individual or group) must have
provided the intellectual direction for the scientific work, and the
work must have been completed while at FDA. The nomination should
reference a completed body of work.

Outstanding scientific contributions for the purposes of these awards
are identified by creative and novel application of science to the
solution of problems related to the regulatory mission of the agency.
Examples of demonstrated accomplishments that these awards recognize
include, but are not limited to, the following:

-   Outstanding scientific efforts that significantly advance the
    agency's consumer protection mission by solving difficult regulatory
    problems.

-   Attainment of exceptional scientific insight or technological
    development that enhances the ability of the agency to make critical
    science-based decisions in an efficient and effective manner.

-   Demonstrated ability to overcome obstacles to regulatory scientific
    objectives resulting in:

    -   new and/or uniquely applied methods of sample analysis,

    -   new and/or uniquely applied methods of regulatory
        decision-making,

    -   improved ability to interpret scientific information submitted
        to the agency,

    -   accomplishment of research that adds substantial knowledge to a
        field of regulatory interest,

    -   innovative application and understanding of regulatory science
        that enables clear communication of important agency policy
        and/or procedural guidance.

**2005 FDA Scientific Achievement Awards**

**AWARD NOMINATION FORM**

To nominate an individual or group for a Scientific Achievement Award,
please complete the following pages:

1\. Complete this Award Nomination Form,

2\. Attach a copy of the nominee's curriculum vitae (condensed version
limited to **five or fewer pages;** see below for details), and

3\. Arrange for two individuals to submit a completed Award Reference
Form (attached) in support of the nomination. Completed Award Reference
forms should be returned to the sponsor in a sealed envelope. The sealed
reference forms should be attached to the completed Award Nomination
Form.

Complete the Award Nomination forms and submit the package to the
chairperson of the respective Center/ORA Scientific Achievement Awards
Selection Committee by **November 5, 2004**. After the review of the
Center/ORA awards selection committee the Chairperson will forward the
Center/ORA nomination packages to Donna L. Mentch, by **November 29,
2004**. The Outstanding Intercenter Scientific Collaboration Award
Nomination forms should be completed and submitted to the Office of
Science and Health Coordination, Donna L. Mentch, by **November 29,
2004.**

Please note that application materials will not be returned.

Nominations must include: (a) completed nomination form, (b) curriculum
vitae, and (c) two reference letters.

**NOTE**: Incomplete packages will be returned. Packages containing more
than two reference letters will be returned.

**CATEGORY**

Choose the category that best applies to the achievement for which the
award is being sought.

(See guidance to determine appropriate awards category on pages 2 and 3)

\_\_\_\_\_\_\_ Excellence in Analytical Science

\_\_\_\_\_\_\_ Excellence in Laboratory Science

\_\_\_\_\_\_\_ Excellence in Review Science

\_\_\_\_\_\_\_ Outstanding Intercenter Scientific Collaboration

\_\_\_\_\_\_\_ Outstanding Junior Investigator

\_\_\_\_\_\_\_ Outstanding Support Scientist

\_\_\_\_\_\_\_ Outstanding New Reviewer

**2005 FDA Scientific Achievement Awards**

**Selection Criteria**

The determining factors the review committees will use to assess the
nominations include:

1**. Scientific Merit**\--How will this contribution be judged by
scientists?

> *Vision and insight*\--has the nominee seen or discerned a need where
> others have not? Has the nominee had some fundamental insight into how
> to meet the need?
>
> *Creativity and Innovation*\--Is the method or application of methods
> a creative yet practical implementation of the vision? Is it elegant
> and powerful?

*Luminosity*\--Does the work open up a problem for others to follow?

2\. **Mission Contribution**\--How well will this contribution help FDA
serve the public?

> *Utility*\--Is the work practical?
>
> *Breadth*\--How far-reaching is the work? (The work does not have to
> be an agency-wide tool to be considered for an award.)
>
> *Potential Impact*\--Will it have an immediate and/or potential impact
> on regulatory decisions, compliance, conduct of clinical trials, etc.?

3\. **Recognition**\--To what extent is the work recognized by
scientific peers within the agency, and when appropriate, outside the
agency?

**2005 FDA Scientific Achievement Awards**

**NOMINEE** (For group awards, attach a separate sheet of paper with the
name, address, position, length of FDA service, and area of professional
specialization for each member.)

**Full name of nominee (individual or group name)**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Degree(s) (Ph.D., M.D., D.V.M., etc.)**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**FDA address and phone number:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Mail Code**: \_\_\_\_\_\_\_ **Check one**: \_\_\_\_\_ Commissioned
Corps \_\_\_\_\_ Civil Service

**Position:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Length of FDA service:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Areas of professional specialization:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**PROPOSED CITATION**

Summarize the nominee's contribution in 25 words or fewer. This will
form the basis for the citation presented to the awardee.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2005 FDA Scientific Achievement Awards**

**CURRICULUM VITAE** (*For groups attach a copy of each member's CV*.)

Attach a copy of the nominee's curriculum vitae. CVs must be limited to
**five or fewer pages**, in 12-point Times New Roman, with one-inch
margins, and should contain the following information:

1.  Name and position of the nominee

2.  Education (beginning with the baccalaureate education and including
    postdoctoral or other professional training). Provide institution
    and location, degree, year degree was conferred, and the field of
    study.

3.  Relevant professional experience, in chronological order.

4.  Publications

5.  Honors

6.  Membership and offices held in professional societies (last 10 years
    only)

7.  Membership on relevant FDA committees (last 10 years only)

**REFERENCES**

Please furnish the names, addresses, and phone numbers of the two
individuals (either within or outside the agency) who have agreed to
complete Award Reference Forms (found in the back of this nomination
package) in support of this nomination. Nominating individual (sponsor)
should send Award Reference Forms to the referees. Sealed envelopes
containing the completed reference forms should be returned by the
referees to the nominating individual and attached to the award
nomination as part of the supporting documentation.

1.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
2. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

*NOTE: No more than two reference letters will be accepted. Letters must
be current and written in support of the 2005 FDA Scientific Achievement
Awards.*

**2005 FDA Scientific Achievement Awards**

**SPONSOR**

Sponsor's name, address, and telephone (please type or print clearly):

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Sponsor's affiliation and title:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

I have known the candidate(s) for \_\_\_\_\_\_\_ years.

Sponsor's signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_­­­­\_\_\_\_\_\_\_\_\_\_\_

**IMMEDIATE SUPERVISOR(S)** (For group nominations use next page.)

Name of nominee's immediate supervisor (please type or print clearly):

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature of immediate supervisor:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date:
\_\_\_\_\_\_\_\_\_\_\_­­­\_\_\_\_\_\_\_\_\_

**2005 FDA Scientific Achievement Awards**

**IMMEDIATE SUPERVISORS (For group nominations only**)

[Member's name]{.underline} [Member's Immediate Supervisor]{.underline}
[Supervisor's Signature]{.underline} [Date]{.underline}

1.\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

2.\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

3.\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

4.\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

5.\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

6.\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

7.\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

8.\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

9.\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

10.\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

11.\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

12.\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_

**2005 FDA Scientific Achievement Awards**

### DESCRIPTION OF SCIENTIFIC ACHIEVEMENT

In the space provided on this page and, at most, on two other pages,
describe the nominee's achievement. Please include the following
sections in the narrative:

1\. statement of problem or issue addressed by the work,

2\. description of significant aspects of the nominee's work and how it
resolved the problem or issue, and

3\. description of the impact on public health.

Please limit to three pages (in 12-point Times New Roman Font).

*Caution: Do not include proprietary information.*

**2005 FDA Scientific Achievement Awards**

**Award Reference Form**

Completed Award Reference Forms should be returned to the sponsor in a
sealed envelope. The completed and sealed reference forms will be
attached to the completed Award Nomination Form and submitted to the
Chairperson of the respective Center/ORA Scientific Achievement Awards
Selection Committee by **November 5, 2004**. After the review of the
Center/ORA awards selection committee the Chairperson will forward the
Center/ORA nomination packages to Donna L. Mentch, by **November 29,
2004.** Nomination packages for the Outstanding Intercenter Scientific
Collaboration Award will be sent to Donna L. Mentch, by **November 29,
2004.**

**To be completed by *sponsor*:**

Candidate's (individual or group) name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Sponsor's name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Accomplishment for which candidate is nominated:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**To be completed by *reference*:**

I have known the candidate professionally for \_\_\_\_\_\_\_\_ years.

My relationship with the candidate is
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

In the space provided on the attached page and, at most, on one other
page, describe your specific knowledge of the candidate's professional
achievements as they relate to this nomination. Comment to the best of
your ability on the scientific merit of the candidate's contribution as
well as its impact on the mission of the Food and Drug Administration.

Submitted by \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature Date

Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**2005 FDA Scientific Achievement Awards**

Narrative description of candidate's scientific/regulatory achievement.
Please limit to two pages.

*Refer to page 11 "Description of Scientific Achievement."*