Nominator
First and Last Name
Title
Organization
Address
Phone
Number
Email
Name of
person being nominated
Category
of nomination (Individual, Provider
Organization, Products/Services)
Nominator
Electronic Signature
Candidate
First and Last Name
Candidate’s Current Position (if
applicable)
Candidate’s Current Organization
Candidate
Address
Candidate
Telephone Number
Attach
Criteria Document File (.doc, .docx, .pdf
or .zip file no larger than 1MB, see
note below)
IMPORTANT NOTE: Please attach any
supporting documentation necessary in
Microsoft Word (.doc or .docx) or Adobe
PDF Format (.pdf). If the size of
your document is larger than 1 Megabyte,
you should use Mac OS X compress or
Windows Zip to compress the document,
and then upload the .zip file. No file
larger than 1 Megabyte can be sent.
