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New Award Application

New Award

	Organization making the request:
	Prefer:	Formal Award Recognition
	Proposed award/recognition name

Criteria

	Award/recognition is based upon:
	Is there a pool of candidates?	Yes No
	If so, what is the pool of candidates?

Financial Impact

	Where is funding originating?
	Will it be funded long term?	Yes No
	If yes, for how long?

Award Years/Length

	How long will award be offered?
	Mature and possible close date:
	Other information for committee:

	Name
	Address
	Phone:
	Fax
	Email:

= required information