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Home » NINOS Landis Mentor Award Nomination Form

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Preview for the "English" version of "NINOS Landis Mentor
Award Nomination Form"
NINOS Landis Mentor Award Nomination Form
Burden Statement

OMB#: 0925-0766 I Exp Date: 04/2023

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching
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sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid 0MB control number. Send comments
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Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0766). Do not return the completed form to this address.

Overview
NINOS invites nominations of outstanding mentors who are more than 20 years from the start of their first tenure-track or equivalent
faculty position (i.e., the start date of their first tenure-track or equivalent faculty position was in calendar year 2001 or earlier). These
nominees will have established a track record of mentorship, where from the earliest stage of their independent research careers
they demonstrated a dedication to helping trainees towards their goal of becoming exceptional, successful, and independent
scientists.

Nominations for the 2023 Landis Award will be accepted through December 15, 2022.

Requirements
To be eligible for this award, mentors must be in a tenure-track or equivalent faculty position and hold an active NINOS R01, R35, U01,
U54, P01, OP1, OP2 or equivalent, 4-5 year duration NIH award, with at least one year left on their grant in June 2023. See a detailed
description of this award.

All fields are required.

Nominate a Mentor
Mentor's First Name*

M entor's Last Name *

Mentor's Last Name *

Mentor's Email *

M�tor's Institution*

First year of first tenure-track position*
- Select -

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Your Information
First Name*

Last Name*

Current Institution

*

Current Position*

Position when mentored *

Mentored from date(year}

*

Mentored to date(year) *

Relationship to nominee*

Please describe the basis for this nomination
Your description should include:
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Please describe the basis for this nomination
Your description should include:

• What made/makes the nominated individual an exceptional mentor/trainer
• What are specific examples of extraordinary dedication to mentors hip you personally experienced or witnessed
• By what specific activities/approaches does the nominee ensure that trainees conduct the highest quality research with respect to
scientific premise, experimental design and analysis
• In what specific ways, or by what actions or approaches, has the nominee influenced your growth as a neuroscientist.

About this mentor
Description *

Inquiries
Please direct all inquiries to:
Stephen Korn, Ph.D.
Director, Office of Training and Workforce Development

Submit

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Form AP-f.lfOVed OMS# 0925-0648 EXf.l. Date 06/2024