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NCSA Service All-Star Nomination Form

» back to All-Star Nomination Guidlines

Please use this form to nominate candidates for the NCSA Service All-Star Awards.

  Fields with an * are required.
  Nominee Information
* Nomination For: Individual
Team / Work Group / Department
Organization Please make a selection.
* Nominee Name:
(Full Name of whom you are nominating)
A value is required.
* Organization Size: 100 or fewer employees
Greather than 100 employees Please make a selection.
* Address 1: A value is required.
Address 2:
* City: A value is required.
* State: Please select an item.
* Zip Code: A value is required.
* Please share why this person, team or organization
deserves to be an NCSA All-Star:

Please keep submissions to approximately 500 words.

  remaining characters A value is required. Exceeded maximum number of characters.

   
  Your Information
* First Name: A value is required.
* Last Name: A value is required.
* Your Relationship to the Nominee: A value is required.
Company:
Job Title / Position:
* Contact Email: A value is required.Not a valid email address.
* Contact Telephone:
Include area code
A value is required.
Contact Fax:
Include area code
* Verification Code: