Name of Nominee and Title

NYC Office and Agency

Nominee's Work Address

Nominee's Phone Number (if available)

How long has the nominee been an employee of NYC government? (estimate if necessary)

What is the nominee's job?

Based on your first-hand knowledge, please comment in detail on the nominee's achievements, according to the following criteria.

Could you please summarize the qualities of the nominee that makes this person worthy of the award?

Can you give an example of the nominee at work that exemplifies his or her talent and expertise?

Can you give an example of the nominee at work that exemplifies his or her commitment?

Can you give an example of the nominee at work that exemplifies his or her innovation?

Can you summarize those qualities that best define this person?

Your name, email, phone and mailing address so that we can confirm our receipt of your nomination and contact you if we need further information.

Name

Your relationship to nominee

Email

Phone

Mailing Address