This form declares your intent to nominate a recipient for the 2012 Lee Founders Award. Nominations, supporting documents, and additional information should be sent no later than April 15, 2012 to:

Dr. Shari Dworkin, Chair, Lee Founders Award Committee
University of California, San Francisco
Social & Behavioral Sciences, 3333 California St., LHTS #455
San Francisco, CA 94118
Work: (415) 476-9487; E-mail: shari.dworkin@ucsf.edu