Please fill out and return to:
NCDS Awards Committee
1600 Evans Road
Cary, NC 27513
Category of Award: ____________________________________________________________________________________________________________________
Name of Nominee: ____________________________________________________________________________________________________________________
His/Her Address: ____________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
Nominating Signatures:
1. _______________________________________________________________
2. _______________________________________________________________
3. _______________________________________________________________
4. _______________________________________________________________
5. _______________________________________________________________
6. _______________________________________________________________
7. _______________________________________________________________
8. _______________________________________________________________
9. _______________________________________________________________
10. _______________________________________________________________
Submitted by:
Name: _______________________________________________________________________________________________________________________________
Date: _______________________________________________________________________________________________________________________________
Telephone(s): _________________________________________________________________________________________________________________________
* Please attach typewritten sheets giving resume of nominee's qualifications for this award and include a brief statement of why this person deserves to be considered for this award.
