ETHICS DISCLOSURE FORM FOR NOMINATORS – Honors & Awards

INSTRUCTIONS: PLEASE RETURN THIS FORM WITH THE NOMINATION PACKAGE NO LATER THAN THE SPECIFIED REQUESTED DATE. IF YOU HAVE QUESTIONS, CONTACT NAN BROADBENT, SSA EXECUTIVE DIRECTOR, AT NBROADBENT@SEISMOSOC.ORG .

The Seismology Society of America (SSA) expects the recipients of awards and honors to embody high standards of scientific integrity, personal accountability and ethics in their professional activities as set forth in SSA’s Professional Ethics Policy. In nominating someone for an SSA award or honor, you play a vital role in upholding SSA’s professional ethics standards. All SSA awards and honors are determined and issued at SSA’s sole judgment and discretion and SSA retains the right to grant, defer, or decline to grant an award or honor to any person. SSA also retains the right to revoke an award or honor already granted, if, in its judgment and discretion, SSA determines that it is in SSA’s best interests to do so.

Nominee Information

Begin typing the name of the institution to locate it within the database. If the institution name does not appear, please type the full institution name to add it to our database.

Nominator’s Declarations

1. To the best of your knowledge, has a court, regulatory agency, employer, or other public or private entity issued a finding against the nominee in which their professional conduct was at issue, including any instances of “Prohibited Conduct” as defined in Section E of SSA’s Professional Ethics Policy?

2. To the best of your knowledge, is the nominee currently under investigation by a court, regulatory agency, employer, or other public or private entity in which their professional conduct is at issue including any instances of “Prohibited Conduct” as defined in Section E of SSA’s Professional Ethics Policy?

Nominator’s Information & Acknowledgment