Please input information below about the person being nominated for an award.

* 1. I would like to nominate the following individual:

* 2. The individual above works for the following institution:

* 3. I would like to nominate the above individual for the following award:

* 4. The individual has been a member of CUCCOA for the following number of years:

* 5. I feel that the individual above deserves the award because: