Mensa Foundation Prize nomination

Nominee Information

Please provide information here on the individual you are nominating.

Organization

First Name

Last Name

Address

Address 2

City

State

ZIP or Postal Code

Email Address

Phone Number

Nominated by:

Self nomination

Someone else

Please also provide your information here as the nominator.

Nominator Information

Organization

First Name

Last Name

Address

Address 2

City

State

ZIP or Postal Code

Email Address

Phone Number

Submission Information

Summary of Nominee’s Scientific Discovery

Describe the scientific discovery in the field of intelligence or creativity in 500 words or fewer.

Nominee's Curriculum Vitae (PDF files only)

Please include the nominee’s curriculum vitae.

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Nominee's Meritorious Bibliography (PDF files only)

Please include the nominee’s meritorious bibliography.

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Letters of Support (PDF files only)

Please include two letters of support from colleagues of the nominee

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Add another file

I have read and understand the rules and conditions set out above and this nominee meets all of them to the best of my knowledge. I agree to accept the judges' decisions as final. I understand that any award may be revoked, in the Mensa Foundation's sole discretion, if the nominee fails to embody the values, mission, and vision of the Mensa Foundation and/or commits acts that negatively affect the reputation and goodwill of the Mensa Foundation and/or American Mensa.