Nomination Submission – Prince Mahidol Award Foundation

Nomination for Prince Mahidol Award 2024

Please visit the criteria pages for more information.

Submission process:

Please fill out the form below completely and correctly. If you do not fill in the required fields, you will receive an error message telling you what to fill in.
In case of individual nomination, please indicate the top 5 publications for each of the nominees (indicate the list in section VIII. PUBLICATIONS)
In case of a joint nomination (group/team), only the top 5 publications are required.
Please upload the publication file or other documents you wish to attach in section X. Attachment
All text and attachments must be written in English. There is no word count limit for any field in the nomination form. KEEP IT BRIEF. Write short sentences that are concise and give specific detail.
Please note that self-nominations are NOT ACCEPTED.
Be sure to click the “Submit Nomination Form” button at the bottom of the form.
Nominations remain active for three consecutive years. If you have nominated someone in the last two years, re-nomination is not required; however, additional or updated documentation may be submitted via email to [email protected]
If you have any questions or should experience technical difficulties with the nomination form, please contact [email protected]
If you have technical difficulties with the online submission, you can alternatively fill out the nomination form (download) and send it together with the relevant documents to [email protected]

The deadline for the 2024 award submissions is May 31, 2024. (local time)

Nomination Submission

I. NOMINEE

Name of institution (s) or individual (s) with title, position and affiliation.

II. MAILING ADDRESS

Please check the box

Office

Home

Address

City

Country

Postal Code

Phone

Fax

E-Mail

Other

III. JUSTIFICATION FOR NOMINATION

III.1 Has the awardee made a scientific contribution of internationally recognized standards which has been shown to be of important benefits to a large number of the people of the world, transcending notional boundary?

III.2 Has the awardee made successfully an application of a body of scientific knowledge to the benefits of a large number of the people of the world, transcending national boundary?

IV. STATEMENT IN SUPPORT OF NOMINATION

Please provide details of the best or the most significant contribution of the candidate.

IV.1 Give objective evidence of the impact of the medical research, health research or health service to a large number of people.

IV.2 Would you care to give the name of other worthy candidate in the same field as the nominee? (optional)

V. AWARDS AND HONOURS RECEIVED

AWARDS AND HONOURS RECEIVED

VI. EDUCATIONAL BACKGROUND

EDUCATIONAL BACKGROUND

VII. POSITIONS OCCUPIED

List the present position (s) and the previous position (s) with dates and durations together with names and addresses of employers.

VIII. PUBLICATIONS

List all important publications. Submit reprints or copies of important ones (not more than five). Attach English abstracts or English translation in case publications are not in English.

IX. NOMINATED BY

Last name

First name

Middle initial

Title

Position

Address

City

Country

Postal Code

Phone

Fax

E-Mail

Other

X. Attachment

Attachment File (PDF or ZIP)

Choose File

Note

Please give full information under Categories III & IV. Well-prepared and verifiable statements will be of value to the nominee(s) and to the selection committees.
Please submit no more than two letters of reference, which may provide additional information and justification for the nomination, together with the nomination form.
A curriculum vitae (CV) of the nominee is required and must be submitted as part of the nomination package. The CV must be written in English only, not exceed five (5) pages in length, and include information covering the past ten (10) years.
In the case where the nominee is an institution, please attach relevant documents outlining the history, status, and key officials of the institution(s). Please use additional pages for each category, as necessary.