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* 1. Name of Award Nominee:

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* 2. Current Position of Nominee:

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* 3. Name of Tribal Justice System, if any:

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* 4. Tribal Affiliation, if any:

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* 5. Work Mailing Address:

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* 6. Telephone:

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* 7. Email Address:

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* 8. Nominator Name:

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* 9. Nominator Current Position:

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* 10. Nominator Name of Tribal Justice System:

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* 11. Nominator Tribal Affiliation, if any:

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* 12. Nominator Work Mailing Address:

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* 13. Nominator Telephone:

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* 14. Nominator Email:

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* 15. Award Categories: 
(Please check the appropriate award category for which your nominee should be considered. You may only nominate a person for one award. Please note that with the exception of the Lifetime Achievement Award, only current NAICJA members are eligible for consideration. If you have a question about a nominee’s membership status, please email: kbriscoe@choctaw.org or call (601) 575-1777.)

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* 16. Description of Nominee's Qualifications for Award:
(In a few concise paragraphs, please describe the accomplishments and contributions of the nominee, tailored to the applicable award. Up to two (2) supporting documents such as reports or articles evidencing the nominee’s qualifications and contributions are welcome to be submitted by email to kbriscoe@choctaw.org)

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