SAME National Award Nomination Form

This nomination form is for SAME Awards and Medals to be presented at the annual Joint Engineer Training Conference & Expo with the exception of the Mentoring Award.

You may complete this form online and click "submit" at the bottom of the page. All award nominations were due by COB Wednesday, Jan. 23, 2013. **The nomination deadline for the NCO Medal has been extended to Wednesday, Feb. 6, 2013.**

You may use this form for any of the awards listed in the drop-down menu below. Other awards with different requirements have different forms.

If you have not already done so, please review the list of awards and their respective criteria on the Society Medals and Awards page before completing this form. Nominations submitted that do not meet the specific award criteria will not be considered.

Required fields are marked with *

Select award for which you are submitting this nomination: *

Award Nominee Information

Prefix/Rank: *

First Name: *

Last Name: *

Suffix:

Address Type: Home Work *

Street Address: *

Suite:

City: *

State: *

ZIP Code: *

Telephone Number: *

Email Address: *

Nominee Personal Information

Is the nominee a SAME member? Yes No *

Nominee's member number (if available):

Is the Nominee a Current or Retired Member of the Uniformed Services? Yes No

If applicable, select service branch:

Professional Certifications (P.E., LEED AP, etc.):

Company/Division/Public Agency for which the nominee works: *

Nominee Employer Address:

Nominee Photo

Upload Nominee Photo: *

Narrative Submission

You may upload the nomination as a separate document below. Please remember that the narrative is to be no longer than 1000 words. Narratives longer than 1000 words will not be accepted and the nominator will need to submit the form again with a narrative of proper length.

Click here for a Narrative Example.

Upload Your Narrative: *

Citation

Please prepare a brief citation of 250 words or fewer, highlighting why this nominee should receive the award. The citation will be edited by SAME HQ and will be included in the Honors Program if the nominee is selected. Compose the citation in another program and upload it below.

Upload Your Citation: *

Nominator Information

Prefix/Rank: *

Your Full Name: *

Suffix:

Your SAME Member Number: *

Are you a current *

Street Address: *

Suite:

City: *

State: *

ZIP Code: *

Your Telephone Number: *

Your Email Address: *

This nomination has been reviewed and approved by the SAME Member nominated above. Yes No *

I have reviewed all criteria for the award for which I am submitting this nominee: Yes No *

Endorsement Information

Please note specific endorsement requirements for each individual award. For most awards, the endorsement for the nomination must come from a Post President or member of the SAME Board of Direction. If the nominator is a Post President/member of the SAME BOD, then they may also endorse the nomination.

Are you a Post President or member of the SAME Board of Direction? *

For the Post Service Medal, nominations must be made by the Post President and endorsed by the respective Regional Vice President.

Are you a Regional Vice President? Yes No *

I am aware that incomplete nominations or nominations that do not meet the specific award criteria will not be considered. Yes No *

Full Name:

Email Address: *

Before you click on “Submit Form” please check your work to ensure accuracy of information. Once you hit “Submit Form,” you will receive an e-mail confirming that your information has been submitted. If you DO NOT get a confirmation e-mail, please contact the SAME Administrative Assistant immediately at dtigue@same.org. Your confirmation e-mail is proof that your form has been submitted.

Thank you for submitting this nomination.

If you have questions regarding this form or the nomination process, please contact the SAME Administrative Assistant, Danielle Tigue at dtigue@same.org.