/ 2006 Call for Nominations
Leadership and Service Awards
Nomination Form
George S. Wham Leadership Medal

Nomination Deadline: Friday, July 14, 2006(5:00 pm EDT)

Please submit all nominations electronically:

/ George S. Wham Leadership Medal
The George S. Wham Leadership Medal honors outstanding contributions by an individual who has provided direction and long-range planning to the ANSI standards federation in commitment and support of the national and/or international standards system or in a specific area of voluntary standardization.
The selection of a recipient for this medal will be primarily based on the individual’s support of international standards and his or her demonstration of direction and long-range planning provided to the ANSI Standards Federation in a specific area of voluntary standardization.

Note: Only one George S. Wham Leadership Medal may be awarded per year. If, in the judgment of the Awards Committee, no candidates meet the eligibility requirements, an award may not be given. The Awards Committee reserves the right to present a nominee with an award other than the one for which he or she was nominated.

Nominee
Name
Employment Status / Please select
Current EmployeeConsultantRetiree
Title*
Organization*
Address
Telephone
Fax
E-mail

*Please include current information unless nominee is retired, then include most recent employer and job title.

Nomination Submitted by (Sponsor)*
Name
Title
Organization
Business address
Telephone
Fax
E-mail

*Nominations may be submitted by any member of the Institute; by members of any ANSI Board, committee council, or other group; or by the members of an ANSI-accredited standards body or certifier. Nominations submitted with the endorsement of an entire group will be considered accordingly.

Sponsor’s Statement
of Authority / This nomination is being submitted on behalf of:
Myself, as an individual sponsorMy employerAn organization that I represent *
*If submitting on behalf of an employer or organization, please indicate that organization’s name below:
Electronic Signature / By checking the box shown at left, I confirm that I am authorized to submit this nomination on behalf of the organization identified above.
If submitting this nomination as an individual, the check box shown at left constitutes your electronic signature.
Statement of Availability / By checking the box shown at left, I confirm that I (or another person designated by me) will be available to participate in the presentation of awards during a formal (black-tie optional) banquet and ceremony on Tuesday evening, October 10, 2006, in Washington, DC, should the nominee identified on this form be selected.
Personal Statement from the Sponsor
Please include a short, PERSONAL STATEMENT (suitable for quotation in the nominee’s biography to the Awards Committee) explaining why you believe this candidate is deserving of the George S. Wham Leadership Medal. Please cite leadership characteristics and one or more specific accomplishments to support your statement.
Summary of Professional Background
Please provide a 100- to 200-word SUMMARY of the nominee’s professional background, promotion of international standards, demonstration of his or her direction and long-range planning provided to the ANSI federation in support of a specific area of standardization, and other relevant factors reinforcing his or her eligibility for the George S. Wham Leadership Medal.
Additional Information
Please include anyadditional relevant information of the nominee’s professional career (a resume or curriculum vitae may be attached).
Nomination Deadline: July 14, 2006 (5:00 pm EDT) / Page 1 of 3