2008 Simon Karecki Award
Nomination Information Form

Please provide the following information regarding the student being nominated:

Name:

University:

E-mail:

Start date of participation in the SRC/NSF CEBSM:

Please provide the following information regarding the nominator:

Name:

Business Address:

Telephone:

E-mail (required for acknowledgment of receipt of nomination):

The nominator is:

• ____ A CEBSM Faculty researcher
• ____ A member of the CEBSM Industry Advisory Board

Please return to the SRCEA with Nomination Description/Narrative and appropriate supporting documentation. E-mail submission to srcea@src.org is preferred. Alternatively, please send to:

U.S. Mail to:
SRC Education Alliance
Simon Karecki Award
P.O. Box 12053
Research Triangle Park, NC 27709

Courier to:
SRC Education Alliance
Simon Karecki Award
Brighton Hall, Suite 120
1101 Slater Road
Durham, NC 27703
(919) 941-9400