| 1. Nominee_________________________________________________________________________ |
| 2. Position__________________________________________________________________________ |
| 3. Place of employment________________________________________________________________ |
| 4. Address__________________________________________________________________________ |
| City__________________________State________________________Zip_____________________ |
| Phone Number(_____)______________________________________________________________ |
| 5. Contact Person____________________________________ Phone (____)_____________________ |
| 6. The nominee has made contributions in the following area(s) |
| __ Advocacy Programs | __ Publications | __ Selection Practice |
| __ Legislation | __ Public Affairs |
| __ Policy Regulations | __ Other_______________________ |
|
| 7. In 100 words or less, please explain the nominee's qualifications for this award. |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| 8. Additional letters of nomination and supporting documents may be forwarded with this form. |
| 9. This nomination was submitted by______________________________________________________ |
| 10. Firm Name_____________________________ 11. Phone no. (____)________________________ |
| 12. Project team members______________________________________________________________ |
| |
Instructions
- If group, enter the name of the group being nominated. If individual, enter the name of the individual being nominated. Place an “X” in the box at the top of the form to indicate if group or individual works in the government or non-government sector.
- If group, leave blank. If individual, enter their position.
- If group, leave blank. If individual, enter their place of employment.
- Enter address, city, state, zip, phone number of group or individual.
- If group, enter the name and phone number of an individual with the group who can provide additional information regarding the group being nominated and/or the procurement process being used.
- Indicated area(s) in which group or individual has made contributions.
- In 100 words or less, explain the group’s or individual’s qualifications, including contributions in areas(s) indicated in #6. Use an additional sheet if space on the form is not adequate.
- Any support documents or letters of nomination can be attached to this form.
- Enter the name of the person who is submitting the nomination.
- Enter the name of the firm that #9 is employed by.
- Enter the firm phone number of the person in #9.
- If nomination is made regarding a particular project, give the name of all consultants and major contractors involved in the project.
|
| Back to the QBS Application page |