Type of NomineeOther Nominee TypeAward CategoryAlternate Category ExplanationNominee Full Legal NamePreferred NameProfessional Title / Rank / PositionOrganization / Agency / DepartmentYears of Service or AssociationEmail AddressTelephone NumberCity / TownStateZIP CodeOrganization Official NamePrimary Contact PersonTitle / PositionEmailTelephoneWebsiteDate of Incident / AchievementService PeriodLocationWhy should this nominee be recognized?Most significant contributionImpact of service or achievement
Measurable benefit?
Yes
No
Unknown
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Beyond ordinary expectations?
Yes
No
Unknown
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DescriptionNominator Full NameOrganization/AffiliationPosition/TitleEmailTelephoneCity/StateRelationship to NomineeOther RelationshipDisclosureDescription