AWARDS NOMINATION FORM

AWARD SELECTION

Please consider this nominee for the following awards(s): You may select more than one

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." If you have problems uploading your documents please email: mailto:awards@aptrweb.org.

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

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