United States Army Public Affairs

Nomination Form for Army Public Affairs Hall of Fame

CRITERIA: The nomination criteria for the Army Public Affairs Hall of Fame and nomination packages will include the following: • A completed nomination form (See Below) • Nominees must be military or civilian U.S. Army Public Affairs professionals who have been retired from active federal service for at least three years. - exceptions will be considered for departure for reasons other than retirement - nominations of deceased PA professionals are not bound by the three-year rule • Nominees must have distinguished themselves through significant and lasting contributions to the profession, history or traditions of U.S. Army Public Affairs. • Nominees who did not retire from active federal service must have: - an exception from the selection panel - served in a superior manner in the profession for a minimum of 15 years

NOMINEE INFORMATION

RANK/GRADE (at retirement) LAST NAME

FIRST NAME MIDDLE NAME

TITLE OR POSITION MOST APPLICABLE TO NOMINATION

STREET ADDRESS

STREET ADDRESS LINE 2

CITY STATE ZIP CODE

PHONE NUMBER EMAIL ADDRESS

IF NOMINEE IS DECEASED: NEXT OF KIN'S INFORMATION

IF DECEASED: DATE OF DEATH

NOK LAST NAME

NOK FIRST NAME NOK MIDDLE NAME

RELATION OF NOK TO NOMINEE

STREET ADDRESS

STREET ADDRESS LINE 2

CITY STATE ZIP CODE

PHONE NUMBER EMAIL ADDRESS

TOP ACHIEVEMENTS • Provide 2-3 examples which are detailed enough to show significant and lasting contributions to Army Public Affairs. Try to crystallize the nominee's contributions. Include a continuation sheet if necessary in a Word or additional PDF document, making sure to send the continuation sheet with this form. The achievement spaces below are not limited in length.

ACHIEVEMENT #1

ACHIEVEMENT #2

ACHIEVEMENT #3

NOMINATOR INFORMATION

RANK/GRADE LAST NAME

FIRST NAME MIDDLE NAME

RELATIONSHIP TO NOMINEE

STREET ADDRESS

STREET ADDRESS LINE 2

CITY STATE ZIP CODE

PHONE NUMBER EMAIL ADDRESS