COGA MIG Outstanding Achievement Award Application
Name
First Name
Middle Name
Last Name
Credentials
Academy Member Number
Are you a current Academy/COGA MIG member?
Yes
No
Which COGA MIG subgroup do you primarily identify with? (Please choose one even if you could identify with more than one.)
Thirty and Under
Fifty Plus
Men
Were you a COGA MIG member at the time of the contribution?
Yes
No
Did the contribution take place within the past 12 months?
Yes
No
Email
example@example.com
Cell Phone Number
-
Area Code
Phone Number
Please provide the mailing address of where a physical award can be sent (if you are selected).
Please upload the following supporting documentation: 1) Resume' or CV; 2) A description of your outstanding contribution in a WORD document - limit to 1,000 words; 3) At least ONE letter of support/recommendation that describes the contribution and it's impact - limit to 5 letters of support; 4) Descriptive supporting documentation [OPTIONAL but highly recommended] such as photos, newsletter articles, newspaper articles, blog articles, etc.
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