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NC SHAPE Service Award Nomination Form

Background: Acknowledges exceptional contributions to NC SHAPE and recognizes singular devotion of time and effort to the programs and mission of NC SHAPE that set the individual apart, even above dedicated members of NC SHAPE. 

Requirements:

  • 5 + years of demonstrated service contributions to NC SHAPE
  • Recipients do not have to be members of NC SHAPE.

Nominee Requirements: 

  • Complete an Application and Upload the Application Documents: Once the Recognition Committee chair receives the nomination, an email will be sent to the nominee with a link to the application form, where the 1-page vita and written statement can be uploaded.

  • Curriculum Vita: Prepare a 1-page curriculum vita highlighting your service contributions to NC SHAPE. 

  • Written Statement: Compose a 250-word statement summarizing your service to NC SHAPE.

  • Format: All uploaded documents must be in PDF format.

If you have questions, contact Artie Kamiya, Executive Director, at 919-818-6486 or artie@ncshape.org.

Nomination Deadline: April 15 of each year.


Nominator's Contact Information




Nominee's Information






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

Is the nominee a member of NC SHAPE?
 Yes    No    I don't know