sakura-logo.png

To visit our sponsors websites, click on the logo!

2020 application

pure-safari-your-logo-here.jpg
Avantik_Logo.jpg
logo_vertical_2017.jpg
EMSlogo300.png
LabStorage-Logo-blue.gif
newcomer.JPG

2020 Texas Society for Histotechnology, Inc.

Grants/Awards Nomination Form

 

Nominee’s/Applicants Name____________________________________________________________________
 

Permanent Address: ____________________________________________________Apt #___________________

 

City____________________ Zip_________________

 

Home Phone: (     )__________________________  Work Phone: (     )________________________________

 

Place of Employment_____________________________________________________________________________

 

Position/Title: ____________________________________________________________________________________

 

Employment Address: ___________________________________________________________________________

 

Supervisor’s Name & Phone: ____________________________________________________________________

 

How long has the Nominee/Applicant been an active member of TSH? ____________________

 

Nominator’s Name: ______________________________________________________________________________

 

Address: _____________________________________________ City: ____________________Zip: ______________

 

Home Phone: (     )__________________________  Work Phone: (     )________________________________

Award: __________________________________________

Description of why you feel this nominee deserves the award:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________