2021 Diversity & Inclusivity Champion Award Nominations

Please complete the nomination form below for the 2021 Diversity & Inclusivity Champion Award.

If you have trouble with the form below, please submit the required nomination information in a single pdf to OHBM Executive Office at info@humanbrainmapping.org by Friday, October 30, 2020.

Full Name: *
Your Institution:
Your Email: *
I would like to nominate (full name): *
A brief statement (in 1000 words or less) outlining the specific actions taken by the individual that demonstrate the reasons for nomination and commenting on the results the nominee's contribution has made to advancing diversity and inclusivity in the field of human brainmapping *
A short biographical statement (no more than two pages) on the nominee, including: Name; Present affiliation; Current mailing address; Current phone, fax and email; Advance professional degrees (including institutions and dates) *
A short list of past and current trainees and mentees (if applicable); URL of website (if available) At least one letter of support from an OHBM member. *

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

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