Membership Nomination

Nominator Information

Please provide the following details about the person doing the nominating.

First Name

Middle Name

Last Name

Preferred (First) Name if different than above

Occupation

Title

Institution

Email Confirmation

Does the nominee know that you are submitting this nomination?

Yes

Nominee Information

Please provide information about the person being nominated.

First Name

Middle Name

Last Name

Preferred (First) Name if different than above

Pronouns used by this person

Email Confirmation

Is the nominee?

Yourself

Someone Else

Nominee’s website or link to research/outreach work

Membership Criteria

Please share your connection to the nominee.

Nominee is a

Researcher

Outreach Specialist

Both

Nominee’s Ph.D. University

Nominee’s Ph.D. Focus

Nominee’s Google Scholar, or Orcid ID

Nominee’s website or online information sharing their work

How does the nominee’s academic interests align with FQxI’s foundational themes.

Describe nominee’s research and/or outreach specialist work on foundational questions in physics or cosmology

Add links to two papers or other materials that show how this nominee is a good fit for FQxI Membership.

Is the nominee from a community that has historically been marginalized or systemically excluded from science?

Yes

Please explain what community they are from that’s historically excluded.

Has the nominee made a large positive impact on a certain community or group? If so, please share.

Any other information you think is relevant to the nomination.

By submitting this form I certify(check all below)

All of the information provided by me in this application is correct, accurate and complete to the best of my knowledge.

I understand that the falsification, misrepresentation or omission of any facts in this form will be cause for dismissal of this nomination form.

I understand that submission of an application does not guarantee my nominee Membership.

I understand I will receive a confirmation of this nomination, but FQxI will not respond separately about this nomination.

I understand FQxI will post new Members to its site on an ongoing basis and I will not get personal notification if the nominee is selected for Membership.

Membership Nomination

Criteria for Membership

Membership benefits include

Nominator Information

Nominee Information

Membership Criteria

By submitting this form I certify(check all below)

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