Year*

Which Individual Award Is This Nomination For?
Program/Project Manager Award (Manager/Key Supervisor in Program or Project Management)Station/General Manager Award (Senior Fuels Manager at the Airport or Staff level)Operations/Facility Manager Award (Supervisor Fuel Distribution or Terminal level operations)Quality/Safety Manager Award (Installation/Field Level)Maintenance Manager Award (Supervisor/Mechanic in hydrant, vehicle, or tank farm)Fuels Supervisor/Operator Award (Supervisor or Operator in Refueling or Tank Farm Operations)

Name, Title, Organization, & Location (Enter the personal identification information of the individual being nominated)*

Work History Brief (Describe the nominee’s duties and responsibilities with emphasis of skills, knowledge and abilities.)*

Performance/Accomplishments (Describe the nominee’s performance and any significant accomplishments. What makes this person stand out above others of similar training and experience.)*

Self Improvement/Community Activities (Explain what the individual has done towards self improvement and the level of effort involved in good citizenship and community activity.)*

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Nominator First Name*

Nominator Last Name*

Nominator Email*

Nominator Phone

Nominator Address 1

Address 2

City

State

Zip

Country

Nominator Title

Nominator Company