WHPE Awards Nomination Form
Please complete for each individual you wish to nominate. Nomination deadline is February 1st.

Following nomination, candidates will receive a request for pertinent biographical information and for letters of recommendation. Completed applications will be submitted to the WHPE Awards Committee for screening and recommendation to the WHPE Executive Committee for final approval.

Please note that all candidates are evaluated using a rubric that is available on the WHPE Awards page under each award listed. Please be sure to submit all the relevant information so that the nominee gets full recognition for their accomplishments.

Nominee (2017 Awards)
First name, Last name
Your answer
Select the award you are nominating this individual for
Nominees Address
Street, City, State, Zip
Your answer
Nominees Home/ Cell Phone Number
Please enter the phone number, including area code, the nominee wishes to be contacted on
Your answer
Nominees Work Phone Number
Please enter the phone number, including area code, the nominee wishes to be contacted on
Your answer
Nominee's Work place
Your answer
Nominee's Work Address
Street, City, State, Zip
Your answer
Nominee's Present position
Title, location, level of employment
Your answer
Nominee's Educational Qualifications
Please list Institution, Major, Dates and the level (Bachelors, Masters, Doctorate, other certifications i.e. NBCT)
Your answer
Nominee's Professional Experience
Please list position, location, and dates
Your answer
Nominee's Professional Memberships/ Affiliations
Check all that apply. List membership numbers, additional membership affiliations AND years of membership for WHPE in "Other" box
Required
Brief summary of nominee's qualifications for the award
Please refer to the award criteria rubric to share specific highlights that qualify the nominee for this award.
Your answer
Please list any District, State, or National committees the nominee has served on or any offices held. You can also include community service projects the nominee has been involved with.
Please include dates
Your answer
Submitted by
Name, Address, Phone Number
Your answer
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