Download N F S

Intergovernmental Forum on Chemical Safety
Global Partnerships for Chemical Safety
SPECIAL RECOGNITION AWARD
NOMINATION FORM
The IFCS will present the
Special Recognition Award at
Forum VI, 15-19 September 2008, Dakar, Senegal
to recognize those contributing in an exceptional way on a
special chemical topic or activity. Individuals, institutions or
groups are eligible for the Special Recognition Award.
The Special Recognition Award is distinguished from the
Award of Merit which recognizes outstanding contributions on
a global scale of a broader scope and nature.
Previous Recipients of the IFCS Special Recognition Award
The first IFCS Special Recognition Award was presented to the International POPs Elimination
Network (IPEN) in 2003 at Forum IV. IPEN is a global network of public interest nongovernmental organizations (NGOs) originally founded to support a common goal of eliminating
persistent organic pollutants (POPs). Through its effective mobilizing and coordination of more
than 350 public health, consumer, environmental, and other NGOs in 65 countries, IPEN
contributed much to the successful negotiations of the Stockholm POPs Convention. Awareness
raising in the general public and involvement of public interest NGOs was a crucial element for
the acceptance and successful completion of the negotiations. IPEN was a key driving force to
fulfil this task.
For more information about the work of IPEN, please visit: http://ipen.ecn.cz/
The second IFCS Special Recognition Award was presented to Professor Dr. Her Royal
Highness Princess Chulabhorn Mahidol of Thailand and the Chulabhorn Research Institute in
2006 at Forum V. The Award was presented in recognition of Her Royal Highness's exceptional
efforts to increase scientific and technical capacities and capabilities for chemical safety through
the work and achievements of the Chulabhorn Research Institute. The Award acknowledges
with deep gratitude the special contributions to the goals of global chemical safety that have
been made by the education and scientific exchange programmes at the Chulabhorn Research
Institute. The wide range of specialized training in science and technology particularly in
toxicology provided by the Chulabhorn Research Institute substantively contributes to building
the national and regional human resources and expertise which are an essential requirement for
chemical safety.
For more information about the work of the Chulabhorn Research Institute, please visit:
http://www.cri.or.th/en/rs_central.php
2
Intergovernmental Forum on Chemical Safety
Global Partnerships for Chemical Safety
SPECIAL RECOGNITION AWARD
Nomination Procedures:
Nominations are accepted from Forum Standing Committee members. Members are
encouraged to consult with their respective constituencies.
This official nomination form is all that Forum Standing Committee members need.
Please complete it fully, including all pertinent information about the candidate’s
qualifications for the special recognition.
The Prize Committee shall be composed of the President and Vice Presidents of the
Forum. The Executive Secretary will act as Secretary to the Prize Committee. The
Committee will make, by majority of its members, a recommendation to the Forum
Standing Committee who will make the final selection.
Deadline for nomination: 15 March 2008.
General Instructions:
Please follow the instructions below, to ensure consideration of your candidate.




Nominations must be typed or printed clearly.
Selection will be based solely upon the information contained in the nomination.
Include relevant facts and figures. Be as specific as possible.
Include as much information about the candidate as possible. Remember,
achievements that you consider obvious may not be known to the Award
Committee. If you wish , you may include letters of recommendation.
3
Intergovernmental Forum on Chemical Safety
Global Partnerships for Chemical Safety
SPECIAL RECOGNITION AWARD
NOMINATION FORM
Deadline for nomination: 15 March 2008
I am pleased to nominate the following candidate for the IFCS Special Recognition
Award and to provide background information for your consideration.
TYPE OR PRINT CLEARLY
Nominee:
Family Name/Name of Organization
_____________________________________________________________________
First Name/Contact Person
Mr/Mrs/Ms/Dr/Prof
_____________________________________________________________________
Address
_____________________________________________________________________
_____________________________________________________________________
City/State/Code
Country
_____________________________________________________________________
Telephone
Fax
_____________________________________________________________________
Give details of the outstanding innovative work in the area of chemical safety that would qualify
the candidate (person or organization) for special recognition.
4
Submitted by FSC member:
Family name:
First Name:
Mr/Mrs/Ms/Dr/Prof
Title:
Telephone:
Fax:
Email:
Date of submission:
Date of receipt in IFCS Secretariat:
Return this nomination form to:
Dr Judy A. Stober
IFCS Executive Secretary
C/o World Health Organization
20 Avenue Appia
CH-1211 Geneva 27, Switzerland
Fax: (+41) 22 791 4875
Email: [email protected]
5