DISTINGUISHED YOUNG AFCEAN (DYA) OF THE YEAR NOMINATION FORM

QUALIFICATIONS - Exceptional service to AFCEA at the local chapter and/or international level

CRITERIA:

INSTRUCTIONS:

Nomination form must be endorsed by an AFCEA Regional Vice President (RVP).  Supporting information is limited to one page; attachments will not be considered.  Duplicate forms are acceptable.  Send completed form to the local AFCEA Chapter President, who will then forward to RVP for endorsement and submission. 

DEADLINE FOR RECEIPT OF NOMINATIONS – NOVEMBER 19, 2005.

All nominations must go first to the local Chapter President, who will forward to the Regional Vice President for final endorsement.

If you have any questions, contact Maureen Cirrito at AFCEA (703/631-6174).

Click here to download the PDF form.

NOMINEE INFORMATION
First Name:
Last Name:
DOB:
Rank:
Title:
Organization:
Address:
City:
State:
ZIP:
Phone:
FAX:
E-mail:
Member Number:
Years:
Chapter:
NOMINATOR INFORMATION
First Name:
Last Name:
Member Number:
Rank:
Title:
Organization:
Address:
City:
State:
ZIP:
Phone:
FAX:
E-mail:
ENDORSEMENTS
Chapter President Endorsement:
RVP Endorsement:
SUPPORTING JUSTIFICATION (Note:  All supporting information must be contained to one page.  Additional pages will not be considered.)
AFCEA BACKGROUND: Association Positions/Committees: (Provide detail – e.g., level of involvement; time in position; accomplishments; specific role played on Committee) Unique contributions to AFCEA (e.g., initiatives taken to foster the goals of AFCEA through member recruiting/participation, sponsorship/development of events, Committee support, etc. Detail candidate’s personal participation and results – e.g., number of members recruited; nominee’s specific contributions to success of event)
PREVIOUS AFCEA AWARDS/RECOGNITION/ACHIEVEMENTS (local or international) : (cite year(s) award(s) received)
BRIEF BIOGRAPHICAL SKETCH: (include general background information, as well as professional achievements)