Credibility in Neuroscience Nomination Form

Your Name ^* (required)

Your email ^* (required)

Nominator's workplace / affiliation (University, NHS Trust, company, institute etc) ^* (required)

To make a nomination you must be a member of the BNA. Please confirm that you are a member. ^* (required)

Yes, I am a BNA Member

Who are you nominating? ^* (required)

I am nominating myself.

I am nominating someone else.

Name of nominee ^* (required)

Nominee's workplace / affiliation (University, NHS Trust, company, institute etc) ^* (required)

Please select the career stage which best describes the nominee's position ^* (required)

Undergraduate student (including preclinical medical students)

Postgraduate student (Masters, PhD, F1/F2 or MD-PhD)

Early career (within 5 years of highest degree / completing F2)

Established researcher / clinical scientist

Research support staff (lab manager, technician etc)

N/A (Team)

Other

Is the nominee aware that you are putting them forward for this prize? ^* (required)

Yes

No

Please complete the below if you are nominating yourself for the Student researcher prize, Individual researcher prize, or you are nominating your team for the Team prize and you are the designated point of contact/team leader. Please select the career role which best describes your position:

Undergraduate student (including preclinical medical students)

Postgraduate student (Masters, PhD, F1/F2 or MD-PhD)

Early career (within 5 years of highest degree / completing F2)

Established researcher / clinical scientist

Research support staff (lab manager, technician etc)

Other

Self-nominations need to be supported by a letter of recommendation. Please confirm that you will ensure this is sent to [email protected]. Self-nominations without letters of support cannot be considered.

I confirm I will submit a letter of support.

Which prize are you making a nomination (or self-nomination) for? ^* (required)

Student researcher prize

Individual researcher prize

Team prize

Why should this person/team be considered for the award? Please make a case for why the nominee should be recognised for their work on strengthening credibility in neuroscience. Please reflect the aims of the Prize when making your case - see https://bnacredibility.org.uk/prizes. (Maximum 4000 characters including spaces). If you prefer, you can send send this to [email protected] as a word document supporting your application. (Maximum 4000 characters including spaces). ^* (required)

Please mention anything else of which you feel the selection committee should be aware when making their decision.

Please confirm that you're aware of the following: o That you have read the eligibility criteria for the BNA Credibility Prize and you/your nominee meet them accordingly. o That you consent to the collection and recording of data for purposes of administering the BNA Credibility Prize and to evaluate it. Details of all nominators and nominees will be retained by the BNA for a period of 8 years; after this period the data will be anonymised and retained indefinitely. o That the BNA may publicise prize winners and their work for which they are being recognised (through interviews, website posts, social media, newsletters etc.) ^* (required)

Yes, I have read and accept these conditions