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Robert P. Shumate National Public Safety and Justice Contributor to Excellence Award Nomination Form
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1.
Please provide the complete set of contact information for the award nominee.
(Required.)
Name
Company
Address
Address 2
City/Town
State/Province
Zip/Postal Code
Email Address
Phone Number
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2.
If selected, will the nominee accept the award?
(Required.)
Yes
No
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3.
Please describe the nominee's most valuable contribution(s). Provide specific examples.
(Required.)
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4.
List stakeholders and beneficiaries of the nominee's contributions. Include name and email information if the stakeholder can provide a testimonial concerning this award nomination.
(Required.)
Stakeholder 1
Stakeholder 2
Stakeholder 3
Stakeholder 4
Stakeholder 5
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5.
Describe the effects and/or outcomes of the nominee's contributions that were discussed earlier. Specifically, how did the nominee's contributions directly affect the improvement of information sharing in the justice, public safety, and/or homeland security domain(s).
(Required.)
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6.
Briefly describe the nominator's relationship with the nominee.
(Required.)
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7.
Please include your contact information as the nominator.
(Required.)
Name
*
Company
*
Address
*
Address 2
City/Town
*
State/Province
*
ZIP/Postal Code
*
Email Address
*
Phone Number
*
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