* Please submit all nominations by March 18, 2016 *
NOMINEE INFORMATION
(person being nominated)
First Name:
Last Name:
Employer:
Address:
City:
State:
Zip:
Work Phone:
Email:
NOMINATOR INFORMATION 
(person submitting the nomination)
First Name:
Last Name:
Work Phone:
Email:
NOMINEE QUESTIONS
Please provide a brief overview and answer the following questions thoroughly about the nominee. The selection committee appreciates all the information you submit and asks you to provide as much detail as possible in a concise manner.