Please complete the below form, filling in all fields. Incomplete forms may result in your thesis not being considered for the prize. To complete the nomination, please email a copy of your thesis to admin@uaces.org before the deadline.

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* 1. Nominee 

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* 2. Contact email

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* 3. Institution and department

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* 4. Title of PhD

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* 5. PhD Submission date

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* 6. Date of passing PhD

Date

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* 7. Viva Date

Date

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* 8. Supporting statement (Max. 150 words)

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