Please fill out this form to submit your nomination for the

College Chemistry Canada General Student Scholarship.

About the Nominee:
First Name: Institution:
Last Name: Academic Year:
Email Address:        


About the Nominator:
First Name: Institution:
Last Name: Mailing Address:
Phone: Address 2:
  EXT: City:
Email Address: Province: Postal code:


Please enter your nomination letter in the text box. Please provide details regarding the nominees contributions to the promotion of chemistry as well as their academic accomplishments. Further details regarding nominations and selection criteria are available here. Additional documentation may be submitted by email. Instructions are provided after you complete your submission.


Please complete all fields.

You may be contacted directly for further details if necessary.

If you make a mistake or need to change something after the fact, please don't resubmit this page, please contact the .