The STFM Recognition Award

Nomination Form

I would like to nominate the following individual for the 1999 STFM Recognition Award.

Nominee ______________________________________________________

Institution ______________________________________________________

Address _______________________________________________________

City: __________________________________________________________

State ___________________________________________ Zip ___________

Phone ______________________________ Fax ______________________

E-mail _________________________________________________________

Nominators are asked to accumulate the items listed in the criteria section and forward them as a packet to the STFM office. Applications not meeting the requirements listed above will be returned to the nominator for resubmission.

Eleven copies of the complete information packets must be postmarked by December 11, 1998. Send nominations to STFM, 11400 Tomahawk Creek Parkway, Ste. 540, Leawood, KS 66211. Contact Stacy Brungardt with questions, 800-274-2237, ext. 5420,
e-mail: tnolte@stfm.org.

Nominator _____________________________________________________

Institution ______________________________________________________

Address _______________________________________________________

City: __________________________________________________________

State ___________________________________________ Zip ___________

Phone ______________________________ Fax ______________________

E-mail ________________________________________________________