National/Council Award Nomination

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Award: *

Nominee Information

Name of Nominee: *

Which service unit does the nominee belong to? *

Enter the business/organization name *

Enter the business/organization contact person's name *

Nominee's Address: *

City: *

State: *

Zip Code: *

Phone: *

E-mail: *

Is nominee registered and screened with the council?

Yes

No

Not sure

In this section, make sure to include how the candidate met the award criteria, their specific accomplishments, the impact the candidate has had, and how they exceeded expectations for their role(s). Include as many details as possible. Click here for tips on how to write a strong nomination.

Current position(s) held by the nominee (including number of years in each position if possible): *

Please describe how the nominee met the criteria for this award. Include details on how she/he delivered outstanding service that made an impact and exceeded expectations for her/his role: *

Since receiving their last award, the nominee has accomplished the following achievements: *

List prior awards received by the nominee (including dates awards were received): *

Nominator and Endorser Information

Name of nominator completing this form: *

Your e-mail: *

How you know the nominee: *

Please list the names and contact information (if known) for the individuals signing the letter of endorsement. Check the award criteria for the number of required signatures on the letter of endorsement for this award.

Name:

E-mail:

Name:

E-mail:

Name:

E-mail:

Name:

E-mail:

Name:

E-mail:

Name:

E-mail:

Published 5/5/16. Updated 2/6/19.

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