2022 Terry Hershey Awards

2022 Terry Hershey Awards

NOMINATION FORM
To review nomination guidelines, please click here to view in a new tab/window. Nomination deadline is Friday, November 12 by 5:00pm.
NOMINATOR INFORMATION
Title
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Co-nominator (optional)

First NameLast Name
Co-nominator (optional)

First NameLast Name
Co-nominator (optional)

First NameLast Name
NOMINEE INFORMATION
I am nominating for the following category:*
Nominee Title
Nominee Name*

First NameLast Name
Nominee Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nominee Email*
example@example.com
Nominee Phone Number*

Area CodePhone Number
OVERVIEW of QUALIFICATIONS

Please provide a brief, but complete description of why the nominee qualifies for the Terry Hershey Texas Women in Conservation Award. It is important to provide specific examples where possible (1,000 word maximum)
Answer*

0/1000
PROFESSIONAL AND COMMUNITY ACTIVITIES

Rather than provide a comprehensive list, please select up to five activities you deem most significant for this award application.
Activity/Organization (1)
Dates of Involvement
Description
Activity/Organization (2)
Dates of Involvement
Description
Activity/Organization (3)
Dates of Involvement
Description
Activity/Organization (4)
Dates of Involvement
Description
Activity/Organization (5)
Description
HONORS AND AWARDS

Rather than provide a comprehensive list, please select up to five honors or awards you deem most significant for this award application.
Honor/Award (1)
Year Received
Honor/Award (2)
Year Received
Honor/Award (3)
Year Received
Honor/Award (4)
Year Received
Honor/Award (5)
Year Received
Signature

I, the nominator, warrant the truthfulness of the information provided in this nomination form, and submit the following as my signature.
Signature*
Please type your first and last name.
Date*

MonthDayYear
Date of Submission
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2022 Terry Hershey Awards

NOMINATOR INFORMATION

NOMINEE INFORMATION

OVERVIEW of QUALIFICATIONS

PROFESSIONAL AND COMMUNITY ACTIVITIES

HONORS AND AWARDS

Signature