2016 Heart of RIMS Nomination Form

www.RIMS.org/Awards

Nominations may be submitted via email to by 5pm ET on Friday, January 13, 2017.

Please provide contact information:

Nominator:

Name:

Company:

RIMS Chapter:

Phone and Email:

Nominee:

Name:

Company:

RIMS Chapter:

Phone and Email:

Section 1 — Individual Attributes:

The following are individual attributes that reflect the qualities necessary to receive this award. Please provide a brief, descriptive example for each question. To illustrate your candidate's contribution, be very specific and use a different example for each question.

A.  How does the candidate promote risk management and RIMS at the chapter level?Activity at the chapter, regional, and/or RIMS (Society) level that benefits the chapter should be included and will be considered. Activity can also be with more than one chapter for the candidate's entire career. Provide specific examples. (Max. 25 points)

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B.  Provide specific examples that demonstratehow the candidate is a team playerwho works well with others Chapter members.(Max. 15 points)

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C.  Provide specific examples of 1) how the candidate addressed a controversial, emerging or challenging issue and 2) demonstrated the ability to facilitatea groupdecision-making process at the Chapter level?(Max. 15 points)

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Section 2 - Positions Held:

Please identify all significant RIMS positions held by the candidate in the past 5 years, including but not limited to Chapter or Society officer, director, committee chair, committee member, etc. Identify the position, timeframe and significant accomplishments for each position held.(Key positions held prior to the most recent 5-year period should be captured in section 5 of the application.) (Max. 20 points)

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Section 3 - Advancing the Risk Management Profession:

How has the candidate advanced the risk management profession at the Chapter level? For example has the candidate:

·  Instructed continuing education and/or professional development courses

·  Advanced professional designations (i.e. RIMS Fellow, ARM, etc.)

·  Advanced Enterprise Risk Management or other emerging industry trends

·  Played an active role in legislative issues at the state or local level

·  Mentored colleagues or students

·  Presented at industry-related seminars (i.e., Chapter or Regional conferences and events)

·  Encouraged Chapter student involvement

Activity at the chapter, regional, and/or RIMS (Society) level that benefittedthe Chapter will be considered. Chapter involvement can also be with more than one Chapter and the benefits achieved should be specifically related. Space is limited. (Max. 20 points)

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Section 4 - Additional Information:

Please provide any additional, relevant candidate information that demonstrates why this individualdeserves the Ron Judd Heart of RIMS award.(Be specific, provide examples and detail the benefits achieved) (Max. 5 points)

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Required Information - Letters of Recommendation:

Two electronic letters of recommendation for the candidate are required for each nominated candidate. Recommendation letters must be from two different sources, (one of which must be from management professional, but the nominator is specifically excluded).Recommendation authors may include colleagues, Chapter board members, educators, students, or members of the RIMS Board of Directors.Members of the Member and Chapter Services Committee may not provide letters of recommendation.

If recommendation letters are not submitted, the entry will not be eligible for consideration. Copies of the electronic letters of recommendation must be pasted into the spaces provided below.

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Reference 1

Source Name:

Source Company:

Relation:

Reference 2

Source Name:

Source Company:

Relation:

I hereby certify that all information in this application is accurate to the best of my knowledge.

Name: Date:

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