Award Nomination Checklist
Complete this form to nominate an individual or team for an award. Please provide all required details and supporting information.
Nominator Full Name
*
First Name
Last Name
Nominator Email Address
*
example@example.com
Relationship to Nominee
*
Nominee Full Name (Individual or Team)
*
First Name
Last Name
Nominee Email Address
*
example@example.com
Nominee Affiliation (Organization, Department, or Team)
*
Award Category
*
Please Select
Leadership
Innovation
Community Impact
Team Excellence
Other
Eligibility Checklist: Please confirm the nominee meets the following criteria.
*
Rows
Yes
No
Nominee has not received this award in the past 3 years
1
2
Nominee is currently active in their field
3
4
Nominee meets all award-specific requirements
5
6
Achievement Assessment: Rate the nominee on the following criteria.
*
Rows
Outstanding
Above Average
Meets Expectations
Needs Improvement
Contribution to their field
7
8
9
10
Impact on community or organization
11
12
13
14
Demonstration of leadership or innovation
15
16
17
18
Collaboration and teamwork
19
20
21
22
Please provide a brief summary of the nominee’s achievements and why they deserve this award.
*
Upload supporting documents (optional, e.g., letters of support, CV, project summaries)
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Reviewer Comments (for internal use)
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