Completing the following questionnaire will further help ensure that the nominee is eligible for this category and will serve as the award nomination. Supporting material should be attached to this form.
Contact Information:
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Person or group
(include contact name)
submitting nomination |
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Phone/email |
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Address |
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City |
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State/Province |
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Zip/Postal Code |
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Name of nominee |
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Address |
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City |
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State/Province |
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Zip/Postal Code |
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Occupation |
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Employer |
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Title/position/phone/email |
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Questions:
1. Please describe the extent to which the nominee’s professional achievements have been recognized;
[ ] Only statewide/province-wide (STOP, the nominee is NOT eligible for this award because the professional achievements are not widely recognized over a large enough area.)
[ ] Multi-state/multi-province
[ ] Nationwide
[ ] International
2. Are the nominee’s accomplishments outside of their normal working duties (i.e. voluntary in nature)?
[ ] Yes
[ ] No (If no, the nominee is NOT eligible for this award.)
3. Describe the nominee’s accomplishments which are compatible with the mission of the Society
4. Briefly explain how the nominee’s accomplishments relate to the Society’s mission.
Supporting Material:
Attach additional pages as needed to complete your responses to the above questions. Summarize information about the nominee’s education, biographical and employment history, honors, and other information, which relates to and supports the nomination.
Award nominations may be submitted by email to sueann.lynes@swcs.org. You may also submit award nominations by U.S. Postal Service (1 copy only) to: SWCS-Awards, 945 SW Ankeny Rd., Ankeny, IA 50023. All nominations must be received by December 12. Both forms of submission will receive a confirmation of receipt. Late nominations will not be considered.
