Berdy Kuiken Service Award

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Submitter Name* This field is required.

First Name

Last Name

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Submitter Email Address* This field is required.

example@example.com

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Submitter Phone Number* This field is required.

Area Code

Phone Number

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Nominee Criteria

Have served, or been actively involved, at the NJCAA Region 4 administrative level (such as an officer, treasurer, awards chair, committee chair/member, sports chair, division rep, or a combination thereof etc.), for a required minimum of eight (8) years, preferably longer

--and/or--

Been a longtime Region 4 representative/officer/voice/chair at a national level (e.g., NJCAA administrative/sports committee(s), NJCAA poll committee(s), coaches’ association officer, NATYCAA rep/officer etc.

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Nominee Name* This field is required.

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Nominee College Information* This field is required.

Current/Former Institutional Position Title

Year(s) in position

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Nominee's Region 4 Experience* This field is required.

What Region 4 position(s) did the nominee serve in?

What year(s) did the nominee serve in the above positions?

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Highlight specific Region 4 service, involvement(s) and contribution details* This field is required.Please provide detailed information

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Please verify that you are human* This field is required.