DSA Nomination Form

DISTINGUISHED SERVICE AWARD NOMINATION FORM

PLEASE READ ALL INFORMATION CAREFULLY BEFORE SUBMITTING
PLEASE NOTE: IT IS THE RESPONSIBILITY OF THE PROPOSER TO PRESENT/FIND SOMEONE TO PRESENT THE WINNER OF THE DSA AT THE BELMAS ANNUAL CONFERENCE. PLEASE MAKE SURE YOU ARE AWARE OF THIS BEFORE SUBMITTING.
Before you get started, please ensure you have the following available to copy and paste/upload:
1. Nominees Name and Email Address.
2. Up to 1000 words describing how the nominee meets criteria point 1 as outlined in the supporting documentation on the BELMAS website.
3. Up to 1000 words describing how the nominee meets at least one of the other five components of the criteria.
4. A minimum of 5 supporting letters consisting of no more than 500-1000 words each.
Please tell us your title:*
Prof/Dr/Mr/Mrs/Miss/Ms/Mx
Please tell us your name:*

First NameLast Name
Please tell us your email address:*
example@example.com
Are you a BELMAS member?*

YesYes, Distinguished Service Award WinnerNo
Please tell us your NOMINEE'S title:*
Prof/Dr/Mr/Mrs/Miss/Ms/Mx
Please tell us your NOMINEE'S name:*

First NameLast Name
Please tell us your NOMINEE'S email address:*
example@example.com
Please tell us how the nominee meets criteria point 1: Active involvement in BELMAS through: long-term membership, presentation of papers, chairing of sessions, involvement on the Board of Trustees/Council or other committees, or other activities of the society. (Consideration may be given to nominees who have not been a BELMAS member, but have contributed to the ELMA field, and so please explain their role within and contribution to the field).*

Max 1000 words0/1000
Please tell us how the nominee meets any of the other criteria points 2-6. This can be found on the BELMAS website*

Max 1000 words0/1000
Supporting Letters*

BELMAS expects a minimum of five (5) supporting letters for each nomination
Cancelof
Should be Empty:

DISTINGUISHED SERVICE AWARD NOMINATION FORM