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Undergraduate Prize for Physiology 2012 - nomination form

More information about this prize is available here. Please note that successful nominees will be published on The Physiological Society's website.

Nomination

Institution: *

Nominator: *

Email: *

Name of student: *

Email of student: *

Degree: *

Reason for nomination

Reason for nominating student: *

Overall performance

Excellent final year project

Please provide full details of exam results, including marks for each component: *

Please provide full details of project marks, including individual components:

This is required for nominations for project performance, but may also be completed for overall performance nominations.

Please provide additional information explaining why this student should be considered for an award: *

Confirmation of award

If there is a date by which you would like to receive confirmation of the award, please provide this below:

We will do our best to work to this deadline.

Additional nominations (optional)

Nominations are also welcome of up to six additional students: three who received the highest course mark and three who received the highest project mark. These students will be offered one year's free membership at The Physiological Society.

Nomination(s) for highest course mark

Name 1:

Name 2:

Name 3:

Nomination(s) for highest project mark

Name 1:

Name 2:

Name 3:

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Undergraduate Prize for Physiology 2012 - nomination form

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