Submit a Nomination Welcome! Thank you for your interest in submitting a nomination forthe 2024 Samuel J. Heyman Service to America Medals. Before you start, please review the eligibility details, our tips for a strong nomination and our FAQs. To save an incomplete nomination and return to it later, click the “Save my progress and resume later” checkbox near the top of each page. If you prefer, you can download the Word version of the form to work on. We strongly prefer online submissions but if that is not possible, you can email them to us once it’s completed. If you have any questions, please contact Maggie Moore at sammies@ourpublicservice.org or (202) 775-6883. Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Nomination Information Medal CategoryPlease select... Career Achievement Emerging Leaders Management Excellence Safety, Security and International Affairs Science, Technology and Environment I'm not sure - please decide for me. Note: The Partnership will determine and assign medal categories based on the nominations received. Please select a nomination category that most closely aligns with the nominee’s work and accomplishment. All finalists will automatically be considered for the Federal Employee of the Year and the People's Choice awards if selected as finalists. You cannot specifically nominate someone for these categories. Nominee Information Note: If you are submitting a team nomination, please fill out the team lead’s information in nominee the sections. The team leader will serve as a spokesman for the team if selected as a finalist. You may provide additional team information in the team information section. SalutationPlease select... Mr. Ms. Mrs. Mx. Dr. Other Other Salutation First Name Last Name Job Title Federal Department or AgencyPlease select... Administrative Conference of the United States Administrative Office of United States Courts Advisory Council on Historic Preservation AmeriCorps Architect of the Capitol Architectural and Transportation Barriers Compliance Board Central Intelligence Agency Chemical Safety and Hazard Investigation Board Committee for Purchase From People Who Are Blind or Severely Disabled Congressional Budget Office Consumer Finance Protection Bureau Consumer Financial Protection Bureau Coordinating Council on Juvenile Justice and Delinquency Prevention Council of the Inspectors General on Integrity and Efficiency Court Services and Offender Supervision Agency Court Services and Offender Supervision Agency for the District of Columbia Defense Nuclear Facilities Safety Board Department of Agriculture Department of Agriculture - Agricultural Marketing Service Department of Agriculture - Agricultural Research Service Department of Agriculture - Animal and Plant Health Inspection Service Department of Agriculture - Economic Research Service Department of Agriculture - Farm Service Agency Department of Agriculture - Food and Nutrition Service Department of Agriculture - Food Safety and Inspection Services Department of Agriculture - Foreign Agricultural Service Department of Agriculture - Forest Service Department of Agriculture - FPAC Business Center Department of Agriculture - National Agricultural Statistics Service Department of Agriculture - National Institute of Food and Agriculture Department of Agriculture - Natural Resources Conservation Service Department of Agriculture - Risk Management Agency Department of Agriculture - Rural Business-Cooperative Service Department of Agriculture - Rural Development Department of Agriculture - Rural Housing Service Department of Agriculture - Rural Utilities Service Department of Commerce Department of Commerce - Economic Development Administration Department of Commerce - International Trade Administration Department of Commerce - Minority Business Development Agency Department of Commerce - National Institute of Standards and Technology Department of Commerce - National Oceanic and Atmospheric Administration Department of Commerce - National Technical Information Service Department of Commerce - National Telecommunications and Information Administration Department of Commerce - U.S. Census Bureau Department of Commerce - U.S. Patent and Trademark Office Department of Defense Department of Defense - Air Force Department of Defense - Army Department of Defense - Defense Acquisition Regulations System Department of Defense - Defense Contract Audit Agency Department of Defense - Defense Criminal Investigative Service Department of Defense - Defense Information Systems Agency Department of Defense - Defense Intelligence Agency Department of Defense - Defense Investigative Service Department of Defense - Defense Logistics Agency Department of Defense - Defense Mapping Agency Department of Defense - Defense Special Weapons Agency Department of Defense - Engineers Corps Department of Defense - Marine Corps Department of Defense - Missile Defense Agency Department of Defense - National Geospatial-Intelligence Agency Department of Defense - National Security Agency/Central Security Service Department of Defense - Navy Department of Defense - Space Force Department of Defense - Uniformed Services University of the Health Sciences Department of Education Department of Energy Department of Energy - Alaska Power Administration Department of Energy - Bonneville Power Administration Department of Energy - Energy Efficiency and Renewable Energy Office Department of Energy - Energy Information Administration Department of Energy - Federal Energy Regulatory Commission Department of Energy - Minority Economic Impact Office Department of Energy - National Energy Technology Laboratory Department of Energy - National Nuclear Security Administration Department of Energy - Southeastern Power Administration Department of Energy - Southwestern Power Administration Department of Energy - Western Area Power Administration Department of Health and Human Services Department of Health and Human Services - Agency for Healthcare Research and Quality Department of Health and Human Services - Agency for Toxic Substances and Disease Registry Department of Health and Human Services - Aging Administration Department of Health and Human Services - Centers for Disease Control and Prevention Department of Health and Human Services - Centers for Medicare & Medicaid Services Department of Health and Human Services - Child Support Enforcement Office Department of Health and Human Services - Children and Families Administration Department of Health and Human Services - Community Living Administration Department of Health and Human Services - Family Assistance Office Department of Health and Human Services - Food and Drug Administration Department of Health and Human Services - Health Care Finance Administration Department of Health and Human Services - Health Resources and Services Administration Department of Health and Human Services - Indian Health Service Department of Health and Human Services - Inspector General Office, Health and Human Services Department Department of Health and Human Services - National Institutes of Health Department of Health and Human Services - National Library of Medicine Department of Health and Human Services - Program Support Center Department of Health and Human Services - Public Health Service Department of Health and Human Services - Refugee Resettlement Office Department of Health and Human Services - Substance Abuse and Mental Health Services Administration Department of Homeland Security Department of Homeland Security - Coast Guard Department of Homeland Security - Federal Emergency Management Agency Department of Homeland Security - Federal Law Enforcement Training Center Department of Homeland Security - National Communications System Department of Homeland Security - Secret Service Department of Homeland Security - Transportation Security Administration Department of Homeland Security - U.S. Citizenship and Immigration Services Department of Homeland Security - U.S. Customs and Border Protection Department of Homeland Security - U.S. Immigration and Customs Enforcement Department of Housing and Urban Development Department of Housing and Urban Development - Federal Housing Enterprise Oversight Department of Housing and Urban Development - Government National Mortgage Association Department of Interior Department of Interior - Fish and Wildlife Service Department of Interior - Geological Survey Department of Interior - Hearings and Appeals Office, Interior Department Department of Interior - Indian Affairs Bureau Department of Interior - Indian Trust Transition Office Department of Interior - Land Management Bureau Department of Interior - Minerals Management Service Department of Interior - Mines Bureau Department of Interior - National Biological Service Department of Interior - National Civilian Community Corps Department of Interior - National Indian Gaming Commission Department of Interior - National Park Service Department of Interior - Natural Resources Revenue Office Department of Interior - Ocean Energy Management Bureau Department of Interior - Ocean Energy Management, Regulation, and Enforcement Bureau Department of Interior - Reclamation Bureau Department of Interior - Safety and Environmental Enforcement Bureau Department of Interior - Special Trustee for American Indians Office Department of Interior - Surface Mining Reclamation and Enforcement Office Department of Justice Department of Justice - Alcohol, Tobacco, Firearms, and Explosives Bureau Department of Justice - Drug Enforcement Administration Department of Justice - Federal Bureau of Investigation Department of Justice - Federal Bureau of Prisons Department of Justice - Federal Prison Industries Department of Justice - Foreign Claims Settlement Commission Department of Justice - Immigration and Naturalization Service Department of Justice - INTERPOL Washington Department of Justice - National Institute of Corrections Department of Justice - National Institute of Justice Department of Justice - Parole Commission Department of Justice - U.S. Marshals Service Department of Labor Department of Labor - Benefits Review Board Department of Labor - Employee Benefits Security Administration Department of Labor - Employment and Training Administration Department of Labor - Employment Standards Administration Department of Labor - Labor Statistics Bureau Department of Labor - Mine Safety and Health Administration Department of Labor - Occupational Safety and Health Administration Department of Labor - Pension and Welfare Benefits Administration Department of State Department of Transportation Department of Transportation - Federal Aviation Administration Department of Transportation - Federal Highway Administration Department of Transportation - Federal Motor Carrier Safety Administration Department of Transportation - Federal Railroad Administration Department of Transportation - Federal Transit Administration Department of Transportation - Great Lakes St. Lawrence Seaway Development Corporation Department of Transportation - Maritime Administration Department of Transportation - National Highway Traffic Safety Administration Department of Transportation - Pipeline and Hazardous Materials Safety Administration Department of Treasury Department of Treasury - Alcohol and Tobacco Tax and Trade Bureau Department of Treasury - Bureau of Engraving and Printing Department of Treasury - Bureau of the Fiscal Service Department of Treasury - Financial Crimes Enforcement Network Department of Treasury - Internal Revenue Service Department of Treasury - U.S. Mint Department of Veterans Affairs Department of Veterans Affairs - National Cemetery Administration Department of Veterans Affairs - Veterans Benefits Administration Department of Veterans Affairs - Veterans Health Administration Environmental Protection Agency Executive Office of the President Executive Office of the President - National Economic Council Executive Office of the President - National Security Council Export-Import Bank Farm Credit Administration Farm Credit System Insurance Corporation Federal Accounting Standards Advisory Board Federal Acquisition Regulation System Federal Communications Commission Federal Deposit Insurance Corporation Federal Energy Regulatory Commission Federal Housing Finance Agency Federal Labor Relations Authority Federal Mediation and Conciliation Service Federal Reserve System Federal Retirement Thrift Investment Board Federal Trade Commission General Services Administration Government Accountability Office Government Ethics Office Government Publishing Office Gulf Coast Ecosystem Restoration Council Institute of American Indian and Alaska Native Culture and Arts Development Inter-American Foundation International Development Finance Corporation Library of Congress Millennium Challenge Corporation National Aeronautics and Space Administration National Archives and Records Administration National Council on Disability National Credit Union Administration National Endowment for the Humanities National Foundation on the Arts and the Humanities National Foundation on the Arts and the Humanities - Federal Council on the Arts and the Humanities National Foundation on the Arts and the Humanities - Institute of Museum and Library Services National Foundation on the Arts and the Humanities - National Endowment for the Arts National Foundation on the Arts and the Humanities - National Endowment for the Humanities National Transportation Safety Board Nuclear Regulatory Commission Office of Management and Budget Office of Personnel Management Office of Science and Technology Policy Office of Special Counsel Office of the Director of National Intelligence Peace Corps Postal Service Securities and Exchange Commission Selective Service System Small Business Administration Smithsonian Institution Social Security Administration Tennessee Valley Authority U.S. African Development Foundation U.S. Agency for Global Media U.S. Agency for International Development U.S. Institute of Peace U.S. International Development Finance Cooperation U.S. Postal Service U.S. Trade and Development Agency U.S. Trade Representative Other Other Federal Department or Agency If applicable, please include the organization's parent agency. E.g. the parent agency for NIST would be Department of Commerce. Nominee Work Email Nominee Work Phone Alternate Contact Name Note: We will utilize alternate contacts to assist with nominee communication. Alternate contacts can be the nominee’s executive assistant or any other preferred secondary contact. Alternate Contact Email Please do not include personal or additional email addresses of the nominee. Nominee's Age Older than 35Age 35 or youngerNote: Nominees for the Emerging Leaders category must be under 35 as of January 1, 2024. Years of Service Please select... 1-5 years 6-10 years 11-15 years 16-19 years 20 or more yearsNote: Nominees for the Career Achievement category must have 20 or more years of civil service as of January 1, 2024. Nominee Office Mailing Address Note: If you are submitting a team nomination, please fill out the team lead’s information in nominee the sections. The team leader will serve as a spokesman for the team if selected as a finalist. You may provide additional team information in the team information section. Address Type United States and TerritoriesInternationalForeign bureaus, missions or embassies should choose "International". Address Information Street Address 1 Street Address 2 City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Other Other State Zip Code Country Address Information Street Address 1 Street Address 2 City Province/State/Territory Postal Code Country Team Information Note: For team submissions, at least one designated team lead is required for recognition purposes. The team leader will serve as a spokesperson for the team if selected as a finalist. Their information should be provided in the Nominee Information section of the nomination form. If desired, up noinations may add up to two people to represent the team as individuals, in addition to the team lead. In total, a maximum of three named team representatives can be identified. For teams larger than three, or if you plan to identify fewer than three team leaders, all other team members will be referred to collectively. For example, see 2020 finalists Christopher M. Janczewski, Zia Faruqui, Kimberly A. Reece and the W2V Team or 2021 finalists Ana Hinojosa, Eric Choy and team. Is this a team nomination?YesNo What is the team's name? Would you like to list additional team members individually?Please select... Yes, one additional team member Yes, two additional team members No, the team name is enough Note: If there are more than two additional team members, please just use the team name as your submission. Team Member 2 SalutationPlease select... Mr. Mrs. Ms. Mx. Dr. Other Other Salutation First Name Last Name Job Title Work Email Work Phone Age Older than 35Age 35 or youngerNote: Nominees for the Emerging Leaders category must be under 35 as of January 1, 2024. Years of Service Please select... 1-5 years 6-10 years 11-15 years 16-19 years 20 or more yearsNote: Nominees for the Career Achievement category must have 20 or more years of civil service as of January 1, 2024. Does Team Member 2 work at the same Federal Department or Agency as the Team Lead?YesNo Federal Department or AgencyPlease select... Administrative Conference of the United States Administrative Office of United States Courts Advisory Council on Historic Preservation AmeriCorps Architect of the Capitol Architectural and Transportation Barriers Compliance Board Central Intelligence Agency Chemical Safety and Hazard Investigation Board Committee for Purchase From People Who Are Blind or Severely Disabled Congressional Budget Office Consumer Finance Protection Bureau Consumer Financial Protection Bureau Coordinating Council on Juvenile Justice and Delinquency Prevention Council of the Inspectors General on Integrity and Efficiency Court Services and Offender Supervision Agency Court Services and Offender Supervision Agency for the District of Columbia Defense Nuclear Facilities Safety Board Department of Agriculture Department of Agriculture - Agricultural Marketing Service Department of Agriculture - Agricultural Research Service Department of Agriculture - Animal and Plant Health Inspection Service Department of Agriculture - Economic Research Service Department of Agriculture - Farm Service Agency Department of Agriculture - Food and Nutrition Service Department of Agriculture - Food Safety and Inspection Services Department of Agriculture - Foreign Agricultural Service Department of Agriculture - Forest Service Department of Agriculture - FPAC Business Center Department of Agriculture - National Agricultural Statistics Service Department of Agriculture - National Institute of Food and Agriculture Department of Agriculture - Natural Resources Conservation Service Department of Agriculture - Risk Management Agency Department of Agriculture - Rural Business-Cooperative Service Department of Agriculture - Rural Development Department of Agriculture - Rural Housing Service Department of Agriculture - Rural Utilities Service Department of Commerce Department of Commerce - Economic Development Administration Department of Commerce - International Trade Administration Department of Commerce - Minority Business Development Agency Department of Commerce - National Institute of Standards and Technology Department of Commerce - National Oceanic and Atmospheric Administration Department of Commerce - National Technical Information Service Department of Commerce - National Telecommunications and Information Administration Department of Commerce - U.S. Census Bureau Department of Commerce - U.S. Patent and Trademark Office Department of Defense Department of Defense - Air Force Department of Defense - Army Department of Defense - Defense Acquisition Regulations System Department of Defense - Defense Contract Audit Agency Department of Defense - Defense Criminal Investigative Service Department of Defense - Defense Information Systems Agency Department of Defense - Defense Intelligence Agency Department of Defense - Defense Investigative Service Department of Defense - Defense Logistics Agency Department of Defense - Defense Mapping Agency Department of Defense - Defense Special Weapons Agency Department of Defense - Engineers Corps Department of Defense - Marine Corps Department of Defense - Missile Defense Agency Department of Defense - National Geospatial-Intelligence Agency Department of Defense - National Security Agency/Central Security Service Department of Defense - Navy Department of Defense - Space Force Department of Defense - Uniformed Services University of the Health Sciences Department of Education Department of Energy Department of Energy - Alaska Power Administration Department of Energy - Bonneville Power Administration Department of Energy - Energy Efficiency and Renewable Energy Office Department of Energy - Energy Information Administration Department of Energy - Federal Energy Regulatory Commission Department of Energy - Minority Economic Impact Office Department of Energy - National Energy Technology Laboratory Department of Energy - National Nuclear Security Administration Department of Energy - Southeastern Power Administration Department of Energy - Southwestern Power Administration Department of Energy - Western Area Power Administration Department of Health and Human Services Department of Health and Human Services - Agency for Healthcare Research and Quality Department of Health and Human Services - Agency for Toxic Substances and Disease Registry Department of Health and Human Services - Aging Administration Department of Health and Human Services - Centers for Disease Control and Prevention Department of Health and Human Services - Centers for Medicare & Medicaid Services Department of Health and Human Services - Child Support Enforcement Office Department of Health and Human Services - Children and Families Administration Department of Health and Human Services - Community Living Administration Department of Health and Human Services - Family Assistance Office Department of Health and Human Services - Food and Drug Administration Department of Health and Human Services - Health Care Finance Administration Department of Health and Human Services - Health Resources and Services Administration Department of Health and Human Services - Indian Health Service Department of Health and Human Services - Inspector General Office, Health and Human Services Department Department of Health and Human Services - National Institutes of Health Department of Health and Human Services - National Library of Medicine Department of Health and Human Services - Program Support Center Department of Health and Human Services - Public Health Service Department of Health and Human Services - Refugee Resettlement Office Department of Health and Human Services - Substance Abuse and Mental Health Services Administration Department of Homeland Security Department of Homeland Security - Coast Guard Department of Homeland Security - Federal Emergency Management Agency Department of Homeland Security - Federal Law Enforcement Training Center Department of Homeland Security - National Communications System Department of Homeland Security - Secret Service Department of Homeland Security - Transportation Security Administration Department of Homeland Security - U.S. Citizenship and Immigration Services Department of Homeland Security - U.S. Customs and Border Protection Department of Homeland Security - U.S. Immigration and Customs Enforcement Department of Housing and Urban Development Department of Housing and Urban Development - Federal Housing Enterprise Oversight Department of Housing and Urban Development - Government National Mortgage Association Department of Interior Department of Interior - Fish and Wildlife Service Department of Interior - Geological Survey Department of Interior - Hearings and Appeals Office, Interior Department Department of Interior - Indian Affairs Bureau Department of Interior - Indian Trust Transition Office Department of Interior - Land Management Bureau Department of Interior - Minerals Management Service Department of Interior - Mines Bureau Department of Interior - National Biological Service Department of Interior - National Civilian Community Corps Department of Interior - National Indian Gaming Commission Department of Interior - National Park Service Department of Interior - Natural Resources Revenue Office Department of Interior - Ocean Energy Management Bureau Department of Interior - Ocean Energy Management, Regulation, and Enforcement Bureau Department of Interior - Reclamation Bureau Department of Interior - Safety and Environmental Enforcement Bureau Department of Interior - Special Trustee for American Indians Office Department of Interior - Surface Mining Reclamation and Enforcement Office Department of Justice Department of Justice - Alcohol, Tobacco, Firearms, and Explosives Bureau Department of Justice - Drug Enforcement Administration Department of Justice - Federal Bureau of Investigation Department of Justice - Federal Bureau of Prisons Department of Justice - Federal Prison Industries Department of Justice - Foreign Claims Settlement Commission Department of Justice - Immigration and Naturalization Service Department of Justice - INTERPOL Washington Department of Justice - National Institute of Corrections Department of Justice - National Institute of Justice Department of Justice - Parole Commission Department of Justice - U.S. Marshals Service Department of Labor Department of Labor - Benefits Review Board Department of Labor - Employee Benefits Security Administration Department of Labor - Employment and Training Administration Department of Labor - Employment Standards Administration Department of Labor - Labor Statistics Bureau Department of Labor - Mine Safety and Health Administration Department of Labor - Occupational Safety and Health Administration Department of Labor - Pension and Welfare Benefits Administration Department of State Department of Transportation Department of Transportation - Federal Aviation Administration Department of Transportation - Federal Highway Administration Department of Transportation - Federal Motor Carrier Safety Administration Department of Transportation - Federal Railroad Administration Department of Transportation - Federal Transit Administration Department of Transportation - Great Lakes St. Lawrence Seaway Development Corporation Department of Transportation - Maritime Administration Department of Transportation - National Highway Traffic Safety Administration Department of Transportation - Pipeline and Hazardous Materials Safety Administration Department of Treasury Department of Treasury - Alcohol and Tobacco Tax and Trade Bureau Department of Treasury - Bureau of Engraving and Printing Department of Treasury - Bureau of the Fiscal Service Department of Treasury - Financial Crimes Enforcement Network Department of Treasury - Internal Revenue Service Department of Treasury - U.S. Mint Department of Veterans Affairs Department of Veterans Affairs - National Cemetery Administration Department of Veterans Affairs - Veterans Benefits Administration Department of Veterans Affairs - Veterans Health Administration Environmental Protection Agency Executive Office of the President Executive Office of the President - National Economic Council Executive Office of the President - National Security Council Export-Import Bank Farm Credit Administration Farm Credit System Insurance Corporation Federal Accounting Standards Advisory Board Federal Acquisition Regulation System Federal Communications Commission Federal Deposit Insurance Corporation Federal Energy Regulatory Commission Federal Housing Finance Agency Federal Labor Relations Authority Federal Mediation and Conciliation Service Federal Reserve System Federal Retirement Thrift Investment Board Federal Trade Commission General Services Administration Government Accountability Office Government Ethics Office Government Publishing Office Gulf Coast Ecosystem Restoration Council Institute of American Indian and Alaska Native Culture and Arts Development Inter-American Foundation International Development Finance Corporation Library of Congress Millennium Challenge Corporation National Aeronautics and Space Administration National Archives and Records Administration National Council on Disability National Credit Union Administration National Endowment for the Humanities National Foundation on the Arts and the Humanities National Foundation on the Arts and the Humanities - Federal Council on the Arts and the Humanities National Foundation on the Arts and the Humanities - Institute of Museum and Library Services National Foundation on the Arts and the Humanities - National Endowment for the Arts National Foundation on the Arts and the Humanities - National Endowment for the Humanities National Transportation Safety Board Nuclear Regulatory Commission Office of Management and Budget Office of Personnel Management Office of Science and Technology Policy Office of Special Counsel Office of the Director of National Intelligence Peace Corps Postal Service Securities and Exchange Commission Selective Service System Small Business Administration Smithsonian Institution Social Security Administration Tennessee Valley Authority U.S. African Development Foundation U.S. Agency for Global Media U.S. Agency for International Development U.S. Institute of Peace U.S. International Development Finance Cooperation U.S. Postal Service U.S. Trade and Development Agency U.S. Trade Representative Other Other Federal Department or Agency If applicable, please include the organization's parent agency. E.g. the parent agency for NIST would be Department of Commerce. Does Team Member 2 work at the same address as the Team Lead?YesNo Address TypeUnited States and TerritoriesInternational (Foreign Bureaus or Embassies should choose this option) Street Address 1 Street Address 2 City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Other Other State Zip Code Country Province/State/Territory Postal Code Country Team Member 3 SalutationPlease select... Mr. Mrs. Ms. Mx. Dr. Other Other Salutation First Name Last Name Job Title Work Email Work Phone Age Older than 35Age 35 or youngerNote: Nominees for the Emerging Leaders category must be under 35 as of January 1, 2024. Years of Service Please select... 1-5 years 6-10 years 11-15 years 16-19 years 20 or more yearsNote: Nominees for the Career Achievement category must have 20 or more years of civil service as of January 1, 2024. Does Team Member 3 work at the same Federal Department or Agency as the Team Lead?YesNo Federal Department or AgencyPlease select... Administrative Conference of the United States Administrative Office of United States Courts Advisory Council on Historic Preservation AmeriCorps Architect of the Capitol Architectural and Transportation Barriers Compliance Board Central Intelligence Agency Chemical Safety and Hazard Investigation Board Committee for Purchase From People Who Are Blind or Severely Disabled Congressional Budget Office Consumer Finance Protection Bureau Consumer Financial Protection Bureau Coordinating Council on Juvenile Justice and Delinquency Prevention Council of the Inspectors General on Integrity and Efficiency Court Services and Offender Supervision Agency Court Services and Offender Supervision Agency for the District of Columbia Defense Nuclear Facilities Safety Board Department of Agriculture Department of Agriculture - Agricultural Marketing Service Department of Agriculture - Agricultural Research Service Department of Agriculture - Animal and Plant Health Inspection Service Department of Agriculture - Economic Research Service Department of Agriculture - Farm Service Agency Department of Agriculture - Food and Nutrition Service Department of Agriculture - Food Safety and Inspection Services Department of Agriculture - Foreign Agricultural Service Department of Agriculture - Forest Service Department of Agriculture - FPAC Business Center Department of Agriculture - National Agricultural Statistics Service Department of Agriculture - National Institute of Food and Agriculture Department of Agriculture - Natural Resources Conservation Service Department of Agriculture - Risk Management Agency Department of Agriculture - Rural Business-Cooperative Service Department of Agriculture - Rural Development Department of Agriculture - Rural Housing Service Department of Agriculture - Rural Utilities Service Department of Commerce Department of Commerce - Economic Development Administration Department of Commerce - International Trade Administration Department of Commerce - Minority Business Development Agency Department of Commerce - National Institute of Standards and Technology Department of Commerce - National Oceanic and Atmospheric Administration Department of Commerce - National Technical Information Service Department of Commerce - National Telecommunications and Information Administration Department of Commerce - U.S. Census Bureau Department of Commerce - U.S. Patent and Trademark Office Department of Defense Department of Defense - Air Force Department of Defense - Army Department of Defense - Defense Acquisition Regulations System Department of Defense - Defense Contract Audit Agency Department of Defense - Defense Criminal Investigative Service Department of Defense - Defense Information Systems Agency Department of Defense - Defense Intelligence Agency Department of Defense - Defense Investigative Service Department of Defense - Defense Logistics Agency Department of Defense - Defense Mapping Agency Department of Defense - Defense Special Weapons Agency Department of Defense - Engineers Corps Department of Defense - Marine Corps Department of Defense - Missile Defense Agency Department of Defense - National Geospatial-Intelligence Agency Department of Defense - National Security Agency/Central Security Service Department of Defense - Navy Department of Defense - Space Force Department of Defense - Uniformed Services University of the Health Sciences Department of Education Department of Energy Department of Energy - Alaska Power Administration Department of Energy - Bonneville Power Administration Department of Energy - Energy Efficiency and Renewable Energy Office Department of Energy - Energy Information Administration Department of Energy - Federal Energy Regulatory Commission Department of Energy - Minority Economic Impact Office Department of Energy - National Energy Technology Laboratory Department of Energy - National Nuclear Security Administration Department of Energy - Southeastern Power Administration Department of Energy - Southwestern Power Administration Department of Energy - Western Area Power Administration Department of Health and Human Services Department of Health and Human Services - Agency for Healthcare Research and Quality Department of Health and Human Services - Agency for Toxic Substances and Disease Registry Department of Health and Human Services - Aging Administration Department of Health and Human Services - Centers for Disease Control and Prevention Department of Health and Human Services - Centers for Medicare & Medicaid Services Department of Health and Human Services - Child Support Enforcement Office Department of Health and Human Services - Children and Families Administration Department of Health and Human Services - Community Living Administration Department of Health and Human Services - Family Assistance Office Department of Health and Human Services - Food and Drug Administration Department of Health and Human Services - Health Care Finance Administration Department of Health and Human Services - Health Resources and Services Administration Department of Health and Human Services - Indian Health Service Department of Health and Human Services - Inspector General Office, Health and Human Services Department Department of Health and Human Services - National Institutes of Health Department of Health and Human Services - National Library of Medicine Department of Health and Human Services - Program Support Center Department of Health and Human Services - Public Health Service Department of Health and Human Services - Refugee Resettlement Office Department of Health and Human Services - Substance Abuse and Mental Health Services Administration Department of Homeland Security Department of Homeland Security - Coast Guard Department of Homeland Security - Federal Emergency Management Agency Department of Homeland Security - Federal Law Enforcement Training Center Department of Homeland Security - National Communications System Department of Homeland Security - Secret Service Department of Homeland Security - Transportation Security Administration Department of Homeland Security - U.S. Citizenship and Immigration Services Department of Homeland Security - U.S. Customs and Border Protection Department of Homeland Security - U.S. Immigration and Customs Enforcement Department of Housing and Urban Development Department of Housing and Urban Development - Federal Housing Enterprise Oversight Department of Housing and Urban Development - Government National Mortgage Association Department of Interior Department of Interior - Fish and Wildlife Service Department of Interior - Geological Survey Department of Interior - Hearings and Appeals Office, Interior Department Department of Interior - Indian Affairs Bureau Department of Interior - Indian Trust Transition Office Department of Interior - Land Management Bureau Department of Interior - Minerals Management Service Department of Interior - Mines Bureau Department of Interior - National Biological Service Department of Interior - National Civilian Community Corps Department of Interior - National Indian Gaming Commission Department of Interior - National Park Service Department of Interior - Natural Resources Revenue Office Department of Interior - Ocean Energy Management Bureau Department of Interior - Ocean Energy Management, Regulation, and Enforcement Bureau Department of Interior - Reclamation Bureau Department of Interior - Safety and Environmental Enforcement Bureau Department of Interior - Special Trustee for American Indians Office Department of Interior - Surface Mining Reclamation and Enforcement Office Department of Justice Department of Justice - Alcohol, Tobacco, Firearms, and Explosives Bureau Department of Justice - Drug Enforcement Administration Department of Justice - Federal Bureau of Investigation Department of Justice - Federal Bureau of Prisons Department of Justice - Federal Prison Industries Department of Justice - Foreign Claims Settlement Commission Department of Justice - Immigration and Naturalization Service Department of Justice - INTERPOL Washington Department of Justice - National Institute of Corrections Department of Justice - National Institute of Justice Department of Justice - Parole Commission Department of Justice - U.S. Marshals Service Department of Labor Department of Labor - Benefits Review Board Department of Labor - Employee Benefits Security Administration Department of Labor - Employment and Training Administration Department of Labor - Employment Standards Administration Department of Labor - Labor Statistics Bureau Department of Labor - Mine Safety and Health Administration Department of Labor - Occupational Safety and Health Administration Department of Labor - Pension and Welfare Benefits Administration Department of State Department of Transportation Department of Transportation - Federal Aviation Administration Department of Transportation - Federal Highway Administration Department of Transportation - Federal Motor Carrier Safety Administration Department of Transportation - Federal Railroad Administration Department of Transportation - Federal Transit Administration Department of Transportation - Great Lakes St. Lawrence Seaway Development Corporation Department of Transportation - Maritime Administration Department of Transportation - National Highway Traffic Safety Administration Department of Transportation - Pipeline and Hazardous Materials Safety Administration Department of Treasury Department of Treasury - Alcohol and Tobacco Tax and Trade Bureau Department of Treasury - Bureau of Engraving and Printing Department of Treasury - Bureau of the Fiscal Service Department of Treasury - Financial Crimes Enforcement Network Department of Treasury - Internal Revenue Service Department of Treasury - U.S. Mint Department of Veterans Affairs Department of Veterans Affairs - National Cemetery Administration Department of Veterans Affairs - Veterans Benefits Administration Department of Veterans Affairs - Veterans Health Administration Environmental Protection Agency Executive Office of the President Executive Office of the President - National Economic Council Executive Office of the President - National Security Council Export-Import Bank Farm Credit Administration Farm Credit System Insurance Corporation Federal Accounting Standards Advisory Board Federal Acquisition Regulation System Federal Communications Commission Federal Deposit Insurance Corporation Federal Energy Regulatory Commission Federal Housing Finance Agency Federal Labor Relations Authority Federal Mediation and Conciliation Service Federal Reserve System Federal Retirement Thrift Investment Board Federal Trade Commission General Services Administration Government Accountability Office Government Ethics Office Government Publishing Office Gulf Coast Ecosystem Restoration Council Institute of American Indian and Alaska Native Culture and Arts Development Inter-American Foundation International Development Finance Corporation Library of Congress Millennium Challenge Corporation National Aeronautics and Space Administration National Archives and Records Administration National Council on Disability National Credit Union Administration National Endowment for the Humanities National Foundation on the Arts and the Humanities National Foundation on the Arts and the Humanities - Federal Council on the Arts and the Humanities National Foundation on the Arts and the Humanities - Institute of Museum and Library Services National Foundation on the Arts and the Humanities - National Endowment for the Arts National Foundation on the Arts and the Humanities - National Endowment for the Humanities National Transportation Safety Board Nuclear Regulatory Commission Office of Management and Budget Office of Personnel Management Office of Science and Technology Policy Office of Special Counsel Office of the Director of National Intelligence Peace Corps Postal Service Securities and Exchange Commission Selective Service System Small Business Administration Smithsonian Institution Social Security Administration Tennessee Valley Authority U.S. African Development Foundation U.S. Agency for Global Media U.S. Agency for International Development U.S. Institute of Peace U.S. International Development Finance Cooperation U.S. Postal Service U.S. Trade and Development Agency U.S. Trade Representative Other Other Federal Department or Agency If applicable, please include the organization's parent agency. E.g. the parent agency for NIST would be Department of Commerce. Does Team Member 3 work at the same address as the Team Lead?YesNo Address TypeUnited States and TerritoriesInternational (Foreign Bureaus or Embassies should choose this option) Street Address 1 Street Address 2 City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Other Other State Zip Code Country Province/State/Territory Postal Code Country Nominator or Submitter Information Are you the nominator or the submitter?Nominator - I'm writing this nomination myselfSubmitter - I'm submitting this nomination on behalf of the nominator Note: If you know the nominee(s), can describe their work and are submitting this nomination yourself, you're the nominator! If you are submitting this on behalf of the person who knows the nominee(s) and can describe their work, you're the submitter! (This includes agency awards coordinators, administrative assistants, etc.) Submitter Information Hint: This is your information, not the nominator's SalutationPlease select... Mr. Ms. Mrs. Mx. Dr. Other Other Salutation First Name Last Name Job Title Employer Submitter Work Email Submitter Work Phone Nominator Information SalutationPlease select... Mr. Ms. Mrs. Mx. Dr. Other Other Salutation First Name Last Name Job Title Employer Relationship to nominee (supervisor, colleague, friend, daughter, etc.) Nominator Work Email Nominator Work Phone Alternate Contact Name Note: We will utilize alternate contacts to assist with nominator communication. Alternate contacts can be the nominator's executive assistant or any other preferred secondary contact. Alternate Contact Email Would the Nominator like to receive email updates on the Samuel J. Heyman Service to America Medals program?Yes, send the Nominator email updates Reference Information Identify and provide contact information for three references who can speak to the impact of the nominee's work. The nominator is automatically considered a reference and should not be repeated below. We strongly recommend:A supervisor or higher-level official who can verify the nominee’s employment status and give the agency’s stamp of approval. Someone who can verify the nomination details and help us better understand the true nature and scope of the accomplishment. This person may also be a beneficiary who can personally speak to direct impact of the nominee’s work. Someone not affiliated with the agency or federal government who can endorse the nominee and their work (e.g. the private sector, nonprofit or academia). Consider name recognition. If possible, include an agency head, corporate representative or foundation head. This person might not have a personal relationship with the nominee, but is willing to give a strong endorsement. Reference #1 SalutationPlease select... Mr. Ms. Mrs. Mx. Dr. Other Other Salutation First Name Last Name Job Title Employer Email Phone Alternate Contact Name Alternate contacts can be the reference's executive assistant or any other preferred secondary contact, but please do not include their personal email address. Alternate Email Reference #2 SalutationPlease select... Mr. Ms. Mrs. Mx. Dr. Other Other Salutation First Name Last Name Job Title Employer Email Phone Alternate Contact Name Alternate contacts can be the reference's executive assistant or any other preferred secondary contact, but please do not include their personal email address. Alternate Email Reference #3 SalutationPlease select... Mr. Ms. Mrs. Mx. Dr. Other Other Salutation First Name Last Name Job Title Employer Email Phone Alternate Contact Name Alternate contacts can be the reference's executive assistant or any other preferred secondary contact, but please do not include their personal email address. Alternate Email Accomplishment Information Accomplishment Summary Summarize the concrete accomplishment for which this person or team should be recognized. Use jargon-free languageThe accomplishments must be related to the nominee's work as a federal employee (in other words, not community, volunteer or active-duty service) In 200 words or less. Accomplishment Description Describe the challenge/ problem, how the nominee solved it and why it is important to the American public. Where possible, include quantifiable outcomes such as dollars saved, or the number of people helped.Explain who the accomplishment benefits and how it benefits them.Indicate when the accomplishment occurred. Except for career achievement nominees, nominations should be timely. Explain how the work was innovative. In 800 words or less reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Save my progress and resume later | Resume a previously saved form Contact InformationYour Rights Under GDPR Nomination Deadline January 5, 2024 NOMINATION SUPPORT Still have questions? Contact Maggie Moore at sammies@ourpublicservice.org or (202) 775-6883. Also, be sure to read our guide to writing a winning nomination. Awards Eligibility FAQs Page header: 2019 Management Excellence Medal recipients Robert Cabana and the Kennedy Space Center Senior Management Team
