NJHC Awards & Prizes Nomination Form
Contact shawn.crisafulli@sos.nj.gov with any questions.
Nominee Name
*
First Name
Last Name
Nominee Title
*
Nominee Professional Affiliation
*
Nominee Email Address
*
example@example.com
Nominee Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this a self-nomination?
*
Yes
No
Reference #1
*
First Name
Last Name
Title (if applicable)
Professional Affiliation
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Reference #2
*
First Name
Last Name
Title (if applicable)
Professional Affiliation
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Award or Prize
*
Richard J. Hughes Award
Awards of Recognition
Why does the nominee deserve this award or prize? (500 words maximum)
*
0/500
Nominee's curriculum vitae (3 pages maximum)
*
Nominator Name
*
First Name
Last Name
Nominator Email Address
*
example@example.com
Nominator Title (if applicable)
Nominator Professional Affiliation
*
Submit
Should be Empty: