Completing the following questionnaire will further help ensure that the nominee is eligible for this category and will sere as the award nomination. Supporting material should be attached to this form.

Contact Information:

Questions:

1. Is the nominee a current member of the Society;

[ ] YES
[ ] NO

2. Are the nominee’s accomplishments outside of their normal working duties (i.e. voluntary
     time to the Society)?

[ ] YES
[ ] NO (If no, the nominee is NOT eligible for this award.)

3. Has the nominee been selected for the Fellow Award in last 5 years?

             [ ]  YES (Not eligible for this award)
             [ ]   NO

4. Describe the nominee's service to the chapter by addressing the following:

     -  Address the link of the specific activity to the objectives, growth, and mission of   
         the Society.  What did it accomplish for the Chapter and/or Society?

     -  Describe the extent of the exceptional time and effort in the activity.

     -  Identify the time period that the activity was performed in
         (i.e. MM/YY to MM/YY)

5.  Identify the committee(s), chapter officer position(s) or other capacity the individual has served.  (If none of the above, the nominee is not eligible for this award.)

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.