NOMINATION FORM 
for
PROFESSIONAL AWARD OF MERIT
North Central Section
The Wildlife Society

1.	Name of Nominee:	                                                                                                          
2.	Address:		                                                                                                          
                                                                                                          

                                                                                                          
	Telephone:	

                                                                                                          
3.	Education:	

	Degree			Year	Institution			Major

	________________	____	___________________________	_______________

	________________	____	___________________________	_______________

	________________	____	___________________________	_______________

4.	Present Position:

5.  	Previous Positions (list most recent first):
	1.	                                                                                                                                     
                                                                                                                                     

	2.	                                                                                                                                     
                                                                                                                                     

	3.	                                                                                                                                     
                                                                                                                                     

	4.	                                                                                                                                     
                                                                                                                                     

6.	Individual is being nominated on basis of:
             _____ A.	Contribution to Knowledge
             _____ B.	Single Outstanding Act
             _____ C.	Leadership Over a Period of Several Years
 

7.	Specific accomplishment of nominee:   

Please attach a narrative or curriculum vitae including as much detail as possible.  A decision regarding 
your nomination will be largely based on the amount and type of information attached.

8.	Submitted by:______________________________             Date:                                             
	Phone number:______________________________             Email: