Nomination Form:
Deadline for submission is
Friday, February 7, 2014 at 5:00 p.m.
Nominations may be emailed to
l.gittingscarlson@msubillings.edu or
mailed to Laura Gittings-Carlson,
MSUB Extended Campus,
1500 University Drive,
Billings, MT 59101
Eligibility:
To be eligible for this award, the
nominee must be an outstanding woman
working in Montana in the elds of Science,
Technology, Engineering, and/or Math.
Honorees are chosen by the Chicks in Science
Committee comprised of MSUB faculty and sta,
and community members who are leaders in their
elds. The Chicks in Science Committee seeks
nominations for outstanding women in
STEM-related elds. Each year Chicks in Science will
recognize two Outstanding Women working in
STEM-related elds.
2014
Chicks in Science
Outstanding Woman in a STEM-related Field
Contact information for the nominee:
First Name: Last Name:
Address:
Phone #: Email:
Questions:
1. In which STEM-related eld(s) does the nominee work?
2. Where does the nominee work?
3. What is her job title?
4. What does she do?
5. Why should the nominee be recognized as an Outstanding Women in a STEM-related eld?
6. How has the nominee impacted girls? Please explain.
7. Has the nominee been a mentor to others? If so, how?
8. Is there anything else you’d like to share about the nominee?
Your Contact Information:
First Name: Last Name:
Address:
Phone #: Email:
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