Mental Attitude Award Nomination Form
Submit your nomination for an individual who exemplifies a positive mental attitude and inspires others.
Nominator's Full Name
*
First Name
Last Name
Nominator's Email Address
*
example@example.com
Nominator's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Nominee's Full Name
*
First Name
Last Name
Nominee's Affiliation or Organization (if applicable)
Your Relationship to the Nominee
*
Please Select
Colleague
Supervisor
Direct Report
Friend
Family Member
Other
Reason for Nomination: Describe how the nominee demonstrates a positive mental attitude and impacts others.
*
Key Qualities Demonstrated by the Nominee
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Resilience in the face of adversity
1
2
3
4
5
Encourages others
6
7
8
9
10
Maintains optimism
11
12
13
14
15
Demonstrates empathy
16
17
18
19
20
Shows perseverance
21
22
23
24
25
Overall Positive Attitude Rating
*
1
2
3
4
5
Please provide an example or story that illustrates the nominee's positive mental attitude.
Has the nominee previously received this award?
Yes
No
Not Sure
Submit Nomination
Should be Empty: