2021 Nomination Form

Welcome! Thank you for your interest in submitting a nomination for the 2021 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.

Nomination Details Nomination FAQs Guide to Writing a Winning Nomination
| 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.

Welcome to the nomination portal for the 2021 Service to America Medals. 
At any time, click 'save my progress' in the upper right hand corner to save your progress and return later. 
If you need assistance, please email [email protected]
Nomination Information

Note: For guidance, please read the category descriptions and criteria.
All finalists will be considered for the Federal Employee of the Year award. You cannot specifically nominate someone for this category.

Nominee Information

Note: If you are nominating a team, please enter the information for a single team lead. You will have the opportunity to recognize other team leaders/members below.








Nominees for the Career Achievement category must have 20 or more years of service as of January 1, 2021.

Nominees for the Emerging Leaders category must be under 35 as of January 1, 2021.

Nominee Contact Information




Nominee Office Mailing Address















Team Information




Additional Team Member Information












Nominees for the Emerging Leaders category must be under 35 as of January 1, 2021.














Additional Team Member Information









Nominees for the Emerging Leaders category must be under 35 as of January 1, 2021.


















Nominator and Submitter Information


Hint: 

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 (this is your information, not the nominator's)









Nominator Information











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











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 or new.

·         For more tips, check out our How to Write a Winning Sammies Nomination guide.

Save my progress and resume later | Resume a previously saved form

Contact Information
Your Rights Under GDPR