Award Nomination Form

AWARD NOMINATION FORM

WHEREAS

WHEREAS, the award known as the is administered by to recognize outstanding achievement in the field specified herein;

WHEREAS, the undersigned Nominator submits this nomination for consideration under the award criteria and agrees to the terms, representations, and consents set forth in this form dated .

NOMINATOR INFORMATION

NOMINEE INFORMATION

SCOPE OF WORK / JUSTIFICATION

Provide a concise but detailed justification describing the nominee's accomplishments, impact, and why the nominee meets the award criteria. Include dates, measurable outcomes, and key collaborators.

SUPPORTING MATERIALS

Check all materials included with this nomination. The Selection Committee may request additional documentation for verification.

PAYMENT TERMS (IF APPLICABLE)

An administrative processing fee may be required for this nomination. Payment of any fee is subject to the schedule below. Failure to remit required fees may result in disqualification of the nomination.

TERM AND TERMINATION

This nomination is effective on the date submitted and remains valid for the award cycle specified below unless earlier withdrawn or disqualified in accordance with the rules set forth by the Awarding Organization.

CONFIDENTIALITY

All nomination materials submitted shall be treated as confidential by the Awarding Organization and its Selection Committee, except that the Organization may disclose nominee names, titles, and excerpts of nomination materials if necessary for the purposes of evaluation, publicity for the award, or compliance with legal obligations. Nominator expressly grants the Organization a non-exclusive, royalty-free license to reproduce and publish submitted materials solely in connection with the award process and related publicity.

GOVERNING LAW

This nomination form and any dispute arising out of or related to the nomination, review, or selection process shall be governed by and construed in accordance with the laws of the state indicated by the Awarding Organization, without regard to its conflicts of law principles. Parties hereby submit to the exclusive jurisdiction of the courts located therefor.

ENTIRE AGREEMENT

This form constitutes the entire understanding between the Nominator and the Awarding Organization with respect to this nomination and supersedes all prior communications and understandings, whether oral or written, relating to the subject matter hereof. No amendment will be effective unless made in writing and signed by authorized representatives of both parties.

CERTIFICATION AND CONSENT

By signing below, the Nominator certifies that the information provided is true and accurate to the best of their knowledge, that they have secured any necessary permissions from the Nominee for submission of the materials, and that they consent to the Organization's use of submitted materials in accordance with the confidentiality clause above. The Nominator further authorizes the Awarding Organization to verify facts and to contact listed references as necessary.

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