Please describe how the nominee has made a contribution to his/her profession. Include professional
memberships, affiliations, publications, special honors, recognitions, and research. (Feel free to attach no more
than one additional typed sheet.)
Please describe how the nominee has made a contribution to his/her community. Include names of civic, service,
and philanthropic organizations for which the nominee has volunteered or served, the nature of service, and the
years involved. (Feel free to attach no more than one additional typed sheet.)
You may submit no more than three (3) additional documents (such as letters of support, newspaper or magazine
clippings, or nominee’s resume) supporting this nomination. Please do not include original materials as they will
not be returned.
Check here if additional materials are enclosed.