Elizabeth Hurlock Beckman Award
2024 Nomination Application FormThe Elizabeth Hurlock Beckman Award honors current or former academic faculty who inspired a former
student “to create an organization which has demonstrably conferred a benefit on the community at large” orinspired a former student “to establish on a lasting basis a concept, procedure, or movement of comparable
benefit to the community at large.” Since 2010, the Elizabeth Hurlock Beckman Award has distributed morethan $3.5 million to 140 professors throughout the United States.
Dr. Elizabeth Hurlock Beckman, a pioneer in the field of psychology and one of the first female psychology
professors at Columbia University, authored nine books and textbooks on child and adolescent psychology,
championed gender equality, and advocated for the advancement of women in academia.
For more information and instructions on submitting this form as part of the nomination application
package, please visit wellsfargo.com/private-foundations/beckman-award-trust. In addition to thisNomination Application Form, supporting materials include, but are not limited to: Cover Letter (optional),
Former Student Personal Narrative Part I, Former Student Personal Narrative Part II, and Letter of Support.
All fields are required.

Nominee
Full Name:(Include designatory letters)

Position:(Example: Current Dean of Business School, XYZ University or Former CEO of Business Name)

Retired:Yes

Phone:

No
Email:

Business Address(No post office box, please)

Street:City:

QSR-06282025-6185152.1.1

State:

Zip:

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2024 Nomination Application Form
Home Address(No post office box, please)

Street:State:

City:

Zip:

Is the nominee a U.S. citizen or U.S. permanent resident alien?
Note: Only United States citizens or United States permanent resident aliens are eligible.

Yes

No

Nominator: Former student
Full Name:(Include designatory letters)

Position:(Example: Current Dean of Business School, XYZ University or Former CEO of Business Name)

Retired:Yes

Phone:

No
Email:

Business Address(No post office box, please)

Street:City:

State:

Zip:

State:

Zip:

Home Address(No post office box, please)

Street:City:

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2024 Nomination Application Form

Former student’s school information
Name of post-secondary school where the Nominee taught the former student:

City:

State:

Type of institution:(Select one)

UniversityCollegeCommunity College

Technical School

Other:

Years the Nominee taught the former student:

Academic or scholarly discipline the Nominee taught to the former student:(Select one)

Psychology

MedicalLaw

Other:

Nominator: If not the former student
Note: While the Nominator is typically the former “inspired” student, anyone may submit a nomination.
If the Nominator is not the former student, complete both Nominator: Former student and this section.

Full Name:(Include designatory letters)

Position:(Example: Current Dean of Business School, XYZ University or Former CEO of Business Name)

Retired:Phone:

YesNo
Email:

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2024 Nomination Application FormBusiness Address(No post office box, please)

Street:City:

State:

Zip:

State:

Zip:

Home Address(No post office box, please)

Street:City:

Former student’s organization, concept, procedure, or movement
Name of former student’s organization, concept, procedure, or movement:

If the former student’s organization is a nonprofit public charity, include EIN #:Date the former student’s organization, concept, procedure, or movement was established:(i.e. XYZ nonprofit organization established March 2019, patent awarded by U.S. Patent & Trademark Office on Dec. 21, 2012)

Which of the following did the Nominee inspire the former student to do?
(Select one)

Create an organization that has demonstrably conferred a benefit on the community at large.
Establish on a lasting basis a concept, procedure, or movement of comparable benefit to thecommunity at large.

Geographic areas served by or benefitting from the former student’s organization, concept,procedure, or movement:

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2024 Nomination Application FormPopulation served by or benefiting from the former student’s organization, concept, procedure, ormovement:

Describe the current and potential impact of the former student’s organization, concept, procedure,or movement:
To the extent possible, please include quantitative and qualitative evidence that supports the impact of this work.

(Continue on next page if more room is needed)
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2024 Nomination Application Form(Continued from prior page)

Certification
I certify that the information on this nomination application form is true and correct to the best of my knowledge.

Nominator:

Date:

How did you hear about nominations for the Beckman Award?
(Check all that apply)

EmailFriend/colleague

Past Beckman Award winner

FacebookWebsite

Other:

LinkedIn

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