SR Awards - Distinguished Service Award

Please submit a cover letter at the end of this form. Self-nomination is not only permitted but encouraged.

Please enter your nominee's contact information:

Name of Nominee: *

Title: *

Institution: *

Address: *

Address continued:

City: *

State: *

Zip: *

Phone: *

E-mail: *

Please enter your contact information:

Nominator's Name: *

Address: *

Address continued:

City: *

State: *

Zip: *

Phone: *

E-mail: *

How has this individual provided distinguished service to the organization as a member of regional or national committees, as a member of the Southern Region Board, or as a national officer?

Describe the individual’s contributions to CUPA-HR and the profession in the form of publications related to HR administration and/or through participation as a conference speaker or coordinator at the regional or national level.

How has this individual demonstrated organizational ability by planning (or assisting in the planning of) regional or national CUPA-HR conferences?

Any additional information to support your nomination:

Cover letter:

Need assistance with this form?