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Nominee: Who should receive the award?
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Name of Nominee*:
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Type of Nominee:
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Contact information for Nominee (name a single individual):
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First Name*:
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Last Name*:
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Affiliation:
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CoC:
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(Hold "Ctrl" to select multiple CoCs)
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Email*:
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Phone:
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Reasons for the Nomination:
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Category:
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Please describe:
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Description:
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Why should the nominee receive an award?
Please include a brief discussion of any measurable outcomes that came from the organization's actions. (400 words or less)
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About you (the Nominator):
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Self Nomination:
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First Name*:
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Last Name*:
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Affiliation:
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Email*:
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Phone:
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