Submit a Nomination

Welcome! Thank you for your interest in submitting a nomination for the 2023 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 [email protected] or (202) 775-6883.

Nomination Information

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 award. You cannot specifically nominate someone for this category. 
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. 







If applicable, please include the organization's parent agency. E.g. the parent agency for NIST would be Department of Commerce.



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.

Please do not include personal or additional email addresses of the nominee.

Note: Nominees for the Emerging Leaders category must be under 35 as of January 1, 2023.

Note: Nominees for the Career Achievement category must have 20 or more years of civil service as of January 1, 2023.
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. 
















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 to two additional team members can be added 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.



Note: If there are more than two additional team members, please just use the team name as your submission. 
Additional Team Member (1)








Note: Nominees for the Emerging Leaders category must be under 35 as of January 1, 2023.

Note: Nominees for the Career Achievement category must have 20 or more years of civil service as of January 1, 2023.



If applicable, please include the organization's parent agency. E.g. the parent agency for NIST would be Department of Commerce.












Additional Team Member (2)








Note: Nominees for the Emerging Leaders category must be under 35 as of January 1, 2023.

Note: Nominees for the Career Achievement category must have 20 or more years of civil service as of January 1, 2023.



If applicable, please include the organization's parent agency. E.g. the parent agency for NIST would be Department of Commerce.












Nominator or Submitter Information

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








Nominator Information










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.


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 current supervisor or higher-level official who can verify the information contained in this nomination.
  • Someone outside of the federal government who can speak to the nominee's accomplishments (e.g. a private sector partner the nominee collaborated with on the accomplishment or someone who benefited directly from their work.)

Reference #1









Alternate contacts can be the reference's executive assistant or any other preferred secondary contact, but please do not include their personal email address.

Reference #2









Alternate contacts can be the reference's executive assistant or any other preferred secondary contact, but please do not include their personal email address.

Reference #3









Alternate contacts can be the reference's executive assistant or any other preferred secondary contact, but please do not include their personal email address.

Accomplishment Information

Accomplishment Summary
Summarize the concrete accomplishment for which this person or team should be recognized. 
  • Use jargon-free language
  • The accomplishments must be related to the nominee's work as a federal employee (in other words, not community, volunteer or active-duty service)

Accomplishment Description
  • Describe the accomplishment 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.
  • Explain what the nominee did that was innovative.

[class^="wpforms-"]
[class^="wpforms-"]