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  nominate a chemical for evaluation by CERHR
 

PLEASE PROVIDE AS MUCH INFORMATION AS POSSIBLE IN THE FORM BELOW SO CERHR CAN PROCESS YOUR REQUEST AND COMMUNICATE A RESPONSE TO YOU REGARDING YOUR NOMINATION.  FOR YOUR NOMINATION TO BE PROCESSED, IT IS NECESSARY TO PROVIDE THE NAME OF THE CHEMICAL YOU ARE NOMINATING, YOUR LAST NAME, YOUR FIRST NAME, AND YOUR E-MAIL ADDRESS.  THE INFORMATION PROVIDED WILL BE USED FOR CERHR PURPOSES ONLY.    Thanks!

Note:
If you only wish to learn how to find more information on a chemical but are not concerned with the nomination process, please address the webmaster at webmaster@cerhr.niehs.nih.gov. 

Enter the name and the CAS Registry number (if known) of the chemical you would like to be considered for nomination (remember, one chemical per form please).  The CAS Registry number is the identifier assigned to each chemical by the Chemical Abstract Service.  The registry number is unique for each chemical.  
*Name of Chemical
CAS Registry Number

Read the following below and share with us the reasons why you would like CERHR to consider this chemical:

1.)  Are there specific issues or facts that prompt you to feel this chemical may affect male or female fertility, the developing child, or young infant?  If so, please describe.

2)  Are there certain activities or uses of materials that you feel may result in significant human exposure?  For example, are you concerned about a product or exposure by food, water, air?  Do you think exposures are continual, occasional, or infrequent?

3)  If your concern is a result of something you have heard or read, please provide a reference or description of the source.


Please provide the following information about yourself  (This information will be used for CERHR purposes only)

*Last Name
*First Name
Company/Affiliation (optional)
Address1
Address2
City State Zip Code 
Country
Phone Fax  
*E-mail address


 
* Fields which need to be completed for submission of chemical nomination.

To view the current list of nominated chemicals, click here:  Nominated Chemicals

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This page last updated:  June 24, 2003