2020 Nomination Form

Welcome! Thank you for your interest in submitting a nomination for the 2020 Samuel J. Heyman Service to America Medals.

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 have any questions, please contact Nola Tolsma at [email protected] or (202) 775-9111. Also, be sure to read our guide to writing a winning nomination.

Nominations will close January 17, 2020.

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Nomination and Nominee Information

Nomination


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.

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

Nominee











Nominees for the Career Achievement category must have 20 or more years of service as of January 1, 2020.


Nominee Contact Information





Nominee Office Mailing Address

Foreign Bureaus or Embassies should choose International













Submitter Information (the person submitting this form)
The Submitter will be added to the Partnership for Public Service’s email list to receive updates on Sammies and other news from the Partnership. You may unsubscribe at any time. 












Official Nominator Information
(i.e., the person who you may be completing this form on behalf of)











Reference Information
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.