William Bell Award Nomination Form
Due February 15, 2018

Please complete the following:

Question Title

* 1. Nominee

Full Name

Title/Position

Organization

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. Nominator

Full Name

Title/Position

Organization

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 3. Selection Criteria Checklist

Individual has served and made significant contributions to the field of accessible transportation and mobility

Individual has made outstanding contribution(s) through practice, research, or policy development to the field of accessible transportation and mobility, both nationally and internationally.

Individual is committed to broadening the number of professionals and disciplines working in the field of accessible transportation and mobility.

Individual has a demonstrated track record in the dissemination of research findings and practical information.

Individual has demonstrated accomplishments and a commitment to outreach and training in accessible transportation and mobility.

Individual possesses the following personal qualities: persistence with grace, dedication to accessible transportation and mobility, persuasiveness, credibility and visibility.

Individual has demonstrated a dedication to the field of accessible transportation, and mobility

Comments

Question Title

* 4. Please attach the nominee's CV

You may upload a PDF (.pdf) or Microsoft Word Document (.doc/.docx)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

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