Burbidge Nomination Form

Nominator Name Nominator Name First Last
(including self-nominations)
Nominee's Full / Legal name Nominee's Full / Legal name First Last
Nominee's Active Email Address

(notification of award sent to this email address)
Nominee's Citizenship
Nominee's Professional Title
Nominee's Current Institution
Nominee's Current And Complete Mailing Address Nominee's Current And Complete Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
UC San Diego Faculty Host Name UC San Diego Faculty Host Name First Last
Preferred Quarter
Number of Visit Weeks
Research Proposal (limit 2 pages, 11 pt. font or larger)

Attach Files
Abbreviated Publications

Attach Files

List 10 Most Representative Publications AND All Publications In The Last Three Years.
Abbreviated Curriculum Vitae (limit 2-3 pages in PDF format)

Attach Files

Do not include comprehensive publications list.
Support letters (combine into a single PDF for submission)

Attach Files

These must include the faculty host letter (unless the faculty host is the nominator), plus any letters from additional faculty across UC San Diego in support of this nomination.
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