2022 Nomination Form

Welcome! Thank you for your interest in submitting a nomination for the 2022 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 Maggie Moore at [email protected] or (202) 775-6883.

Nomination Details Guide to Writing a Winning Nomination

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Welcome to the Nomination Portal for the 2022 Service to America Medals
Note: If you need assistance, please email [email protected]For guidance, please read the category and special criteria descriptions. For additional information, please visit our Frequently Asked Questions page. At the discretion of program administrators, all nominations will be considered for additional categories, if appropriate.  

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. 








Note: Nominees for the Career Achievement category must have 20 or more years of civil service as of January 1, 2022.                                                                                                                                                 

Note: Nominees for the Emerging Leaders category must be under 35 as of January 1, 2022.                                                                                                                                                                                              




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. 
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, 2022.

Note: Nominees for the Career Achievement category must have 20 or more years of civil service as of January 1, 2022.                                                                                                                                                                                                                














Additional Team Member (2)











Note: Nominees for the Emerging Leaders category must be under 35 as of January 1, 2022.

Note: Nominees for the Career Achievement category must have 20 or more years of civil service as of January 1, 2022.                                                  














Nominator or Submitter Information
Note: Anyone can submit a nomination, but they'll need to be familiar with the nominee's work and accomplishments. 

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. 
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. The Submitter is often the alternate contact for the Nominator.  Feel free to enter the Submitter's information in the alternate contact field under the Nominator section.

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. We encourage you to provide a reference from outside of the federal government who can speak to the nominee's accomplishments. Each reference should be able to speak to the impact of the nominee's work. 
Reference #1









Reference #2









Reference #3









Accomplishment Information

Accomplishment Summary

Accomplishment Description