Nominator's Contact Information

Nominator's First and Last Name:

Nominator's Email:

Nominator's Phone Number:

Nominee's Information

Nominee's First and Last Name:

Nominee's Email:

Nominee's Phone Number:

Nominee's Title/Position:

Nominee's School/Company/Organization:

Has the individual agreed to be nominated?
 Yes, they have
 No, they have not
 I have not informed them of the nomination

Why does this person deserve this award or recognition? Please limit your response to 300 words.