SAME Online Nomination Form for the
Walter O. Bachus Gold Medal

Nominee Information

Prefix/Rank: *

Full Name: *

Suffix:

Street Address: *

Suite:

City: *

State: *

ZIP Code: *

Telephone Number: *

Email Address: *

Nominee Personal Information

Please verify that the nominee is an SAME member? Yes No *

Nominee's member number (if available):

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

If applicable, select service branch: USA USMC USN USAF USCG USPHS USAR USARNG USANG

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

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

Company/Division/Public Agency Full Address:

Narrative Submission

Please upload the nomination narrative as a separate document below. Please remember that the nomination narrative for the Bachus Gold Medal is to be no longer than 10 pages, double-spaced. Narratives longer than 10 pages and/or not double-spaced will not be accepted and the nominator will need to submit the form again with a narative of proper length.

Click here for the Narrative Templates.

Please upload your narrative: *

Citation

Please prepare a brief citation of 250 words or fewer, highlighting why this nominee should receive the Gold Medal. 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.

Please upload your citation:

Photo

Please upload a color photograph of the nominee in .jpg or .tif, at a resolution of 300 dpi. *

Nominator Information

The nominator must be a member of SAME.

Prefix: *

Full Name: *

Suffix:

SAME Member Number: *

Street Address: *

Suite:

City: *

State: *

ZIP Code: *

Telephone Number: *

This nomination has been reviewed and approved by the SAME Member being nominated for the Gold Medal: Yes No *

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

I realize that failure to address specific criteria or submit a completed nominations packet may preclude my nominee from consideration: Yes No *

Endorsement Information

Please note that 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.

Full Name: *

Email Address: *

Are you a Post President? Yes No

Are you a member of the SAME Board of Direction? Yes No

Endorsement Letter

Please use the field below to upload your endorsement letter. If you have more than one letter, please combine all into one document for upload.

Upload your endorsement letter: