3.0 Distinguished Service Award Request

Background: This award is presented to a member of IMCUSA for sustained contributions recognized to be exemplary of Distinguished Service at either national or chapter level or a combination of service. It recognizes continued service and demonstration of strong, long-term support of IMCUSA in multiple venues. Awardees have earned a reputation for uncommon, excellent performance whose value to IMCUSA is easily recognized by the awarding organization.

Qualifications:

Distinguished service performed at the chapter level

  • Minimum of five (5) years of active service in a leadership role
  • Recommendation of:
  • Six (6) members-in-good-standing, Three (3) members must be Certified Management Consultants® (CMC®)
  • Approval by the chapter’sBoard of Directors

Distinguished service performed at the national level

  • Minimum of five (5) years of active service in a leadership role
  • Three (3) years at the national level and Two (2) years at the chapter level; OR
  • Five (5) years active service at national level if an At-Large Member
  • Requires recommendation of:
  • Six (6) members-in-good-standing, Three (3) must be Certified Management Consultants® (CMC®)
  • Approval by the IMCUSA Recognition and Awards Committee

Process:

Submit national application to National Executive Director () and chapter applications to the chapter’s president at least eight weeks prior to event planned for award to allow time for National Recognition and Awards Committee approval and for placing the order and shipping for the event. Upon approval, the recipient will be notified at least four weeks prior to the presentation event.

Awards are presented by Chapter Presidents, the IMC USA Chair, or the IMC USA Committee Chair at a Chapter, Regional, or National meeting as appropriate. Ideally awards would be presented in the decorum appropriate to the award at a local or national event, conference or annual meeting.

When a chapter award is approved, a copy of this application is to be retained by the chapter and the chapter board meeting minutes record the board’s approval. A completed copy is also sent to the Executive Director with instructions for wording; for mailing award to the Chapter President; and permanent retention. When a national award is approved, a copy of this application is to be retained by the Executive Director along with a copy of the IMC USA Recognition and Awards Committee approval.

To initiate the process, please complete the application on the following pages:

Nominee Personal Information

Name (nominee)______(If a CMC, year earned) ______

Company name ______

Address ______

City ______State ______Zip code ______

Chapter Affiliation ______(At-Large if not a member of a local chapter)

Phone number ______Is candidate aware of nomination? Yes No

Candidate web page address______E-Mail address ______

Distinguished Service Background (Reason Award is Requested)

 Chapter Distinguished Service Award Chapter Name ______

 National Distinguished Service Award

Describe Distinguished Service and Achievements (please be as specific as possible):
______
______
______
______

IMCUSA Service

Chapter offices held (include date): 1. ______2. ______

3. ______4. ______5.______

National offices held (include date): 1. ______2.______

3. ______4. ______5.______

Chair positions held (include date): 1. ______2.______

3. ______4. ______5.______

Awards received from IMC USA:

Award #1 ______From: ______Date ______

Award #2 ______From: ______Date ______

Award #3 ______From: ______Date ______

Award #4 ______From: ______Date ______

Other accomplishments for IMCUSA:

______
______
______
______

Description of Consulting Practice

______
______
______
______

Sponsor Affirmations

Sponsorship of this application requires six (6) IMC USA members’ signatures (three (3) members must be CMC®’s). Sponsors may be contacted to answer specific questions regarding the candidate’s application.

CMC® Sponsor #1 ______Date ______

Phone number ______E-mail ______

CMC® Sponsor #2 ______Date ______

Phone number ______E-mail ______

CMC® Sponsor #3 ______Date ______

Phone number ______E-mail ______

Sponsor #4 ______Date ______

Phone number ______E-mail ______

Sponsor #5 ______Date ______

Phone number ______E-mail ______

Sponsor #6 ______Date ______

Phone number ______E-mail ______

Please submit this application to either:

 Chapter President for Chapter AwardChapter Name: ______

 Executive Director for National Award

3.0 Distinguished Service ApplicationMarch 2, 2015Page 1 of 3