NATIONAL BLACK POLICE ASSOCIATION

NATIONAL AWARD NOMINATION FORM

Please Print or Type

  1. Nominator Name_________________________________________________________
  2. Nominee Information
    1. Nominee Name____________________________________________________
    2. Nominee Age______________________________________________________
    3. Nominee Title/Position_______________________________________________
    4. Location (City/State)________________________________________________
    5. Award Nominated for________________________________________________
    6. Major Achievements:
      1. ___________________________________________________
      2. ___________________________________________________
      3. ___________________________________________________
      4. ___________________________________________________
  1. Educational Background
      1. ___________________________________________________
      2. ___________________________________________________
      3. ___________________________________________________
  1. Community Involvement
      1. ______________________________________________________________________________________________________
      2. ______________________________________________________________________________________________________
      3. ______________________________________________________________________________________________________
  1. Other special recognition received (last five years)
      1. ___________________________________________________
      2. ___________________________________________________
      3. ___________________________________________________
      4. __________________________________________________
  1. Professional Membership Organization
      1. ______________________________________________________________________________________________________
      2. ______________________________________________________________________________________________________
      3. ______________________________________________________________________________________________________
  1. Area of Law Represented
      1. ___________________________________________________
  1. Work Experience (last five years)
      1. ___________________________________________________
      2. ___________________________________________________
      3. ___________________________________________________
      4. ___________________________________________________

Attach corresponding information to support award criteria.