Nomination Form

**Please keep in mind an individual or division can only receive the award once a year. If someone received the award as part of a division, they can be nominated again as an individual for a different reason.

Today’s Date:


Nominator’s Name (optional):


Name(s) of Nominee(s):


Nominee’s Division:


Reason for Nomination
Please be as specific as possible. The Recognition Team may not be familiar with the work of the individual/division. Please keep the nomination guidelines in mind as you complete this form.

How has the nominee contributed to the MDHFS or City goals?

View MDHFS Goals View City Goals

Please email this form to either
Bill Smoger or Diane Haugesag. You can also submit this form via the Skipper Award Nomination folder in the PSC 510 Break Room.

Last updated Sep 10, 2012