APTR Awards Nomination Form

* Please consider this nominee for the following awards(s):

Duncan Clark Award (must be a current APTR member)

F. Marian Bishop Outstanding Educator of the Year Award (must be a current APTR member)

Special Recognition Award (open to all)

NOMINEE INFORMATION

* Name of Nominee:

* Organization:

* Title:

* Address:

* City:

* State:

* Zip Code:

Country:

* Phone:

Fax:

E-mail:

NOMINATED BY

* Name of Nominator:

* Organization:

* Title:

* Address:

* City:

* State:

* Zip Code:

Country:

* Phone:

Fax:

* E-mail:

SUPPORTING DOCUMENTS

The following supporting documents are required. You may attach them to this form by browsing to the file location on your computer, selecting the document and choosing "save." You may also e-mail the documents to: mailto:awards@aptrweb.org (Awards Program - as the Subject Header) if you have problems using this form. Be sure to include the nominated individual's name in the subject.

Current C.V. of the nominated individual:

One-page biographical statement:

Statement of Evidence (letter of support justifying nomination):

ADDITIONAL DOCUMENTS

Any information that supports your reason for nomination is encouraged. This may include: career highlights, University service, honors and awards, publications, and community service. The total additional supporting documents should not exceed 10 pages in length (including appendices).

1. Additional Documents

2. Additional Documents

3. Additional Documents

4. Additional Documents

5. Additional Documents

THANK YOU FOR YOUR NOMINATION

Enter your email address if you would like to have a copy of this completed form e-mailed to you.

* Indicates Response Required