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. Is the nominee a current member of the Society?
[ ] Yes
[ ] No (If no, the nominee is NOT eligible for this award)
2. Is the nominee a Fellow?
[ ] Yes (If yes, was this honor received within the past 5 years?)
[ ] Yes (If yes, the nominee is NOT eligible for this award.)
[ ] No
3. Has the nominee performed distinguished service to the Society for at least 10 years?
[ ] Yes (If yes, please describe to adequately substantiate the nomination.)
[ ] No (If no, the nominee is NOT eligible for this award)
4. Describe the nominee’s service to the Society.
5. Briefly explain how the nominee’s service(s) relates 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. Provide specific and comprehensive information on the nominee's service to the Society (e.g. positions held, activities, achievements), as well as specific information on the nominee's professional activities. If the candidate's career and service involved different jurisdictions, ensure that adequate information is given regarding service to other Chapters and locations. The nomination must also be accompanied by a Professional Curriculum Vitae.
The Award Nomination Questionnaire and supporting material may be emailed to: sueann.lynes@swcs.org. If emailing, you may fax the signed petition to 515-289-1227. You may also submit the Award nomination 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. All forms of submission will receive a conformation of receipt. Late nominations will not be considered.
