2018 Nomination Form


Welcome! Thank you for your interest in submitting a nomination for the 2018 Samuel J. Heyman Service to America Medals.

If you have any questions, please contact Amy Mayer at sammies@ourpublicservice.org or (202) 464‑5382. Also, be sure to read our guide to writing a winning nomination.

The fields required to SAVE a nomination are preceded by a red Required for save:.

All fields are required to SUBMIT a final nomination unless marked as optional.


Nomination and Nominee Information

Not sure which category to select? Read the category descriptions and criteria for guidance. Please note that all finalists will be considered for the Federal Employee of the Year award. You cannot specifically nominate someone for this category.

At the discretion of the program administrators, all nominations will be considered for additional categories, if appropriate. But, if you would specifically like to nominate the same candidate for multiple categories, you must repeat the nomination process for each category.

If YES, please enter only nominee information below for a single team leader. You will have the opportunity to recognize other team leaders/members in the Accomplishment Description.

Nominees for the Career Achievement category must have 20 or more years of service as of January 1, 2018.


Nominator Information


Submitter Information
optional

Please complete this section if you are not the official nominator but are entering the nomination on his/her behalf. As the submitter, you will automatically receive program updates that are sent to the nominator. We will also contact you if we have questions regarding the completed nomination.


References

Identify and provide contact information for three references, including a current supervisor or higher level official, who can verify the information contained in this nomination. The nominator is automatically considered a reference and should not be repeated below.

Reference #1
Reference #2
Reference #3

Accomplishment Information

In one or two sentences, please identify the specific accomplishment(s) for which you are nominating this person or team. The primary accomplishment must be related to the nominee’s work as a federal employee (i.e., not community, volunteer or active duty service).

In 800 words or less:

  • Describe the accomplishment and why it is important to the nation. Where possible, include quantifiable outcomes (e.g., dollars saved or number of people helped).
  • Explain who the accomplishment benefits and how it benefits them.
  • Indicate when the accomplishment occurred.
  • Explain what the nominee did that was innovative.
  • If this is a team nomination, provide the team name and number of team members. If there are more than two or three team members, you do not need to identify them at this time.

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After clicking the SAVE or SUBMIT button below, your browser will show a confirmation page and you will receive a confirmation email at the Nominator and Submitter email addresses entered above. If your browser remains on this nomination form, the nomination was not processed. Should this occur, please review the form carefully to ensure the required fields are completed. If you have any questions, please send an email to sammies@ourpublicservice.org or call Amy Mayer at (202) 464-5382.