NEW HAMPSHIRE PLANNERS ASSOCIATION
2017 AWARD NOMINATION SUBMISSION FORM
Please electronically submit this form and any attachments to NHPA by April 14, 2017 @ 5:00pm to .
I hereby nominate for a 2017 NHPA Annual Planning Award.
This submission is for (Check ONE of the following categories):
Citizen Planner
Professional Planner
Project of the Year
Plan of the Year
Section A:
The following items are mandatory. Submissions lacking these items will not be considered:
1. 2017 NHPA Award Nomination Submission Form
2. One-page summary of the submission or the individual's ELIGIBILITY
3. Three-page explanation demonstrating how the individual, project or plan meet the stated CRITERIA.
4. One letter of recommendation in support of the submitted project or plan or three letters of recommendation for citizen planner or professional planner nominations.
5. A completed NNECAPA Checklist (below).
The following items are optional. Submissions lacking these items will still be considered:
6. Related documents or reports titled:
7. Audio or video presentations titled:
7. Other materials supporting the submission:
Section B:
Information about the submission coordinator (nominator or person nominating the individual or organization for the award). Submission coordinator will work with NHPA’s awards committee in obtaining additional information and will serve as a liaison between the nominee and the committee.
Name: / Title:Company/Organization:
Address:
City: / State: / Zip Code:
Phone: / Fax: / E-mail:
Best form of contact: ______
Section C, Nominator Information:
Please provide additional nominator contact information if different than or in addition to that provided above in Section B.
Name: / Title:Company/Organization:
Address:
City: / State: / Zip Code:
Phone: / Fax: / E-mail:
Section D :
Please provide the names of up to two individuals, other than the nominator, to be notified in the event this submission is selected to receive an award. If this submission is for an individual, that person must be listed below as one of the two contacts:
Name: / Title:Company/Organization:
Address:
City: / State: / Zip Code:
Phone: / Fax: / E-mail:
Name: / Title:
Company/Organization:
Address:
City: / State: / Zip Code:
Phone: / Fax: / E-mail:
Additional Checklist Guidance Form for Citizen Planner, or Professional Planner for NECAPA
The first two items are for citizen planner and professional planner. Check just one of those, then go on and check all appropriate lines and fill in as much information that you can to support that item. Instead of providing separate narratives under each question, you have the option of putting it all under one narrative on a separate sheet, which should be attached as part of this document.
Check one box only:
1. q Serves as a volunteer on a committee, board or commission or as citizen activist
Names of board(s) ______
Citizen activist or neighborhood leader ______
2. q Is or has been making a living as a professional planner serving on behalf of New Hampshire, on the local, regional or state level or in the private sector (for example, consultant) Brief description
Check all that apply:
3. q Committed ______(#) of years to planning, as part of a group, program, initiative and/or cause. Give details:
4. q Dedicated to advocating the best principles of planning as exhibited through sustained work effort, volunteerism, or in daily life. List example(s)
5. q Key contributor in the development and/or implementation of innovative plans, policies, programs or initiatives that have made an impact. List example(s)
7. q Sphere of influence (check all that apply):
q Local
q Regional
q State-wide
q Interstate basis
8. q Has increased the understanding of planning principles and the planning process through his, her or their actions. List example(s)
9. q Exhibited outstanding leadership in his, her or their endeavors. List example(s)
10. q Is respected and emulated by peers. List example(s)
11. q Actively involved in public outreach and citizen engagement. List example(s)
12. q Wrote a book or publication related to planning. List title(s)
13. q Other
I certify that the submitted work was done by the parties credited and meets all eligibility requirements. I understand that any entry that fails to meet submission requirements by April 14, 2017 @ 5:00pm, will be disqualified. Signed must be authorized to represent those credited.
Signature of Nominator: / Date: