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Synergy Awards for Innovation Nomination Form

Nomination form
Complete this form and use it as a cover letter for your application, which should be a maximum of six 8.5" x 11" (21.5 cm x 28 cm) sheets that respond to the points detailed under Nomination Process and Selection Criteria on the Call for Nominations page.

Note: Incomplete or illegible nominations will be rejected. Refer to the Nomination Checklist to ensure that your nomination package is complete.
Jump to "Nominated by"
Jump to "Primary industrial partner"
Jump to "Primary university partner"
Jump to "Additional university and industrial partners"
* Title of Project:
* Award Category: Small and medium-sized Companies
Large companies
Two or more companies
Leo Derikx Award
 
Nominated by
* Name:
* University/Company:
Title/Position:
Address:

City:
Province/State:
Postal/ZIP Code:
* Telephone:
Fax:
* E-mail:
* denotes a required field
Primary university partner
Name:
University:
Title/Position:
Address:

City:
Province/State:
Postal/ZIP Code:
Telephone:
Fax:
E-mail:
 
Primary industrial partner
Name:
Company:
Title/Position:
Address:

City:
Province/State:
Postal/ZIP Code:
Telephone:
Fax:
E-mail:
 
Additional university and industrial partner(s)
This form allows you to enter as many additional university and industrial partners as needed. Enter up to five partners at a time, then select Save. When you are presented with the summary screen, select Modify your nomination. You will be presented with the previous additional university and industrial partner(s) and space for five new partners.

Note: To delete a partner you have already saved, select the Delete check box and the partner will be removed when you select Save.
Additional partner #1
Name:
University/Company:
Title/Position:
Address:

City:
Province/State:
Postal/ZIP Code:
Telephone:
Fax:
E-mail:
Additional partner #2
Name:
University/Company:
Title/Position:
Address:

City:
Province/State:
Postal/ZIP Code:
Telephone:
Fax:
E-mail:
Additional partner #3
Name:
University/Company:
Title/Position:
Address:

City:
Province/State:
Postal/ZIP Code:
Telephone:
Fax:
E-mail:
Additional partner #4
Name:
University/Company:
Title/Position:
Address:

City:
Province/State:
Postal/ZIP Code:
Telephone:
Fax:
E-mail:
Additional partner #5
Name:
University/Company:
Title/Position:
Address:

City:
Province/State:
Postal/ZIP Code:
Telephone:
Fax:
E-mail:
Save your form
When you select Save, you will be presented with a summary of your submission and a text version will be sent to the nominator's e-mail address.

Contained in the summary will be a link that you can follow to make further updates to your submission. The summary will also contain the ID Key associated with your nomination. You can enter the ID Key at the top of this form and select Load as an alternative to following the link in your summary.



Deadline for nominations: April 15, 2012
Send your printed and signed nomination to:

Synergy Awards for Innovation
NSERC
350 Albert Street
Ottawa, ON
K1A 1H5
Tel.: 613-992-5606
Fax: 613-992-5337

A peer review selection committee will decide if a partnership is suitable for an award. All decisions are final. If no partnership demonstrates excellence, no award will be made. Entry material will not be returned to the entrants. Winners will be notified by letter following the selection committee meeting and will be recognized at an event hosted or co-hosted by NSERC. NSERC reserves the right to release the entrants' names and a brief description of their partnerships. Any additional disclosures will be made in consultation with the entrants, but no claim may be made against NSERC as a result of such disclosures. The signatures of the university and industrial partners constitute their agreement to be bound by these rules.
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