2019 Examiner Application
Verification of Management Support

2019 Recognition Cycle

Please direct questions to Holly Bender at hbender@imec.org.

Applications are due by Friday, April 5, 2019.

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Serving as a member of the IMEC Recognition Program Board of Examiners is a unique opportunity for professional and personal growth, and benefits organizations throughout Illinois that strive for enterprise excellence. Examiners can apply the knowledge gained to their home organizations--including experience in understanding and applying concepts of process improvement, developing analytical and consensus-building skills, and familiarity with a systems perspective.

By completing this survey you verify your support of the Examiner applicant(s) to pursue this professional development opportunity through the IMEC Recognition Program.

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* 1. Examiner Applicant(s) Name

Applicant 1

Applicant 2 (if applicable)

Applicant 3 (if applicable)

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* 2. Manager Name

First

Last

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* 3. Employer

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* 4. Manager Title

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* 5. Address:

Mailing Address 1

Mailing Address 2

City

State

Zip

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* 6. Phone Number:

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* 7. Manager Email Address:

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* 8. As the manager/supervisor of fill in name in provided textbox , I understand the required time commitment and responsibilities of an examiner, and I will support and encourage his/her contributions throughout the process. I understand that if he/she does not finish the 2019 Award Cycle an additional fee of $600.00 will be charged for dropping out of the program.

Manager Electronic Signature

Date