VRA Award Nomination Form

Award

Nominee

Nominee's Email Address

Nominee's Address

Nominator Name

Nominator's Email Address

Nominator Address

Nominator Phone Number

Please provide a statement detailing why the nominee is deserving of the award. Please provide historical information that supports the nomination.

Please upload additional supporting documents from others knowledgable of the nominee's outstanding accomplishments

Upload any additional supporting documentation (Nominee's resume, Nominee's curriculum vita, etc)