Nomination Form: IPAC Lieutenant Governor's Medal of Distinction in Public Administration 2025

Nomination Form: IPAC Lieutenant Governor's Medal of Distinction in Public Administration

2025
Date of submission

MonthDayYear
Date
Nominee
Nominee Phone

Area CodePhone Number
Nominee Email
example@example.com
Nominator
Nominator Title
Nominator Phone

Area CodePhone Number
Nominator Email
example@example.com
Statement of Confirmation: I confirm that to the best of my knowledge the information contained in this nomination package is complete and accurate. I also confirm that I have the original signed and dated letters of reference included in the nomination package in my possession. These and any additional documents from other external sources included in the nomination package are available for review by the Selection Committee upon request.

I agree
Additional Comments
Upload the following documents all in one PDF file making sure to include:
1. Nomination Letter: a cover letter (one to two pages) that includes contact information for the nominee and the nominator(s) and an overview of the content of the nomination package.
2. Biography: a summary of the nominee’s educational background, positions held, civic and professional involvement and other relevant information (three to five pages).
3. Supporting Statement: maximum of 2 pages summarizing how the nominee meets the criteria.
  Accomplishments: description of the key accomplishments and achievements of the nominee as they relate to the selection criteria (maximum three pages).
4. References: letters from three to six persons in support of the nomination.
  Nominations are considered for 3 years, including the year of nomination.
  The selection committee’s decisions are solely based on information provided on the nomination form.
5. The names of nominees and the ranking of nominees by the selection committee shall be confidential.
Nominations are open until June 08, 2026.
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