Distinguished Service Award Nominating Form

Distinguished Service Award nomination form

Use this form to submit a nomination for the Distinguished Service Award. If you prefer to print out a form, fill it out by hand, and mail it to the NACC offices, go back to the Awards page.

Please complete this form for each certified NACC member nomination submitted. This submission must include a 300-word statement in which you describe the nominee’s activities in support of NACC’s mission or the mission of chaplaincy and the reason the nominee deserves to be honored with this award (a box is provided on the form, below, in which you can type or paste the statement).

PART 1 - Information about the nominee:

TITLE:

FULL NAME:

ADDRESS:

CITY:

STATE:

ZIP CODE:

COUNTRY:

HOME PHONE:

WORK PHONE:

E-MAIL:

No. of years you've been a member of NACC:

EXECUTIVE SUMMARY (25-word summary of 300-word statement)

PART 2 - Information about you (nominator)

TITLE:

FULL NAME:

ADDRESS:

CITY:

STATE:

ZIP CODE:

COUNTRY:

HOME PHONE:

WORK PHONE:

E-MAIL:

No. of years you've been a member of NACC:

EMPLOYER:

POSITION:

PART 3 - 300-word statement

You can type your statement directly into this box, or cut-and-paste from another location (such as an MSWord file).

STATEMENT:

To the nominator: The NACC is grateful for your assistance in honoring outstanding service on behalf of its members. The process and criteria NACC uses in its selection of the award winner can be found here.