RGASS Nomination Form

Royal Ghassanid Academy of Arts and Sciences Nomination

Please fill out this form to nominate someone to become a Fellow or receive the Order of Arts and Scineces.
Nominate for the Rank of*

Honorary and Senior Fellows for LifeResearch FellowAssociate FellowMember/Royal Order of Arts and SciencesStudent MemberYouth Ambassador
Reason For Nomination*

Explain why your nominee deserves the selected award.0/1500

2. Nominee Information
Nominee's Name*

First NameLast Name
Nominee's Phone Number*

Area CodePhone Number
Nominee's E-mail Address
Nominee's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current Institution/University and Position, if applicable.
Provide any websites on the nominee
Additional website on the nominee
Additional website on the nominee
Include any documentation, such as a CV, on nominee.

3. Your Information *nominator*
Your Name*

First NameLast Name
Your E-mail Address*
Relation to Nomination?*
I.e. Self, Spouse, Child, Co-worker, Boss.......
Your Phone Number*

Area CodePhone Number
Your Address

Street Address

Street Address Line 2

CityState

Zip Code
Please verify that you are human*
Should be Empty: