Instructions: Forward three copies of this form and six sets of nomination materials to individual selection committee chairs prior to November 1, 1997.

Name of award_______________________________________________________________
Nominee _____________________________________________ Office phone ______________
Office address_____________________________________________________________________________
__________________________________________________________________________________________
(city)                                             (state)          (zip)

Nominee requirement checklist:

1. Member of the Midwestern Section of ASAS or Midwest Branch of ADSA.
2. Not more than 40 years of age on nomination deadline.
3. Has not received a national ASAS, ADSA, PSA or AMSA award in the same area.
4. Living at the time of nomination.

Nominator _________________________________________ Office phone ______________
Office address _____________________________________________________________________________
__________________________________________________________________________________________
(city)                                             (state)          (zip)

Is nominator currently a paid-up member of ASAS or ADSA? Yes _____ No _____ If no, please list name and address of a co-nominator who is currently a paid-up member.

Co-Nominator______________________________________ Office phone _______________
Office address _____________________________________________________________________________
__________________________________________________________________________________________
(city)                                             (state)          (zip)

To Nominator: ____________________________________________________________________________

This is to acknowledge receipt of nomination materials on (date received) ______________________.

______________________________________________________
      Selection Committee Chair

The Awards Selection Committee has selected this year's recipient and we wish to inform you of the status of your nomination:

______ 1. Congratulations, your nominee has been selected as a winner. Please keep this information confidential.
______ 2. The committee members independently evaluated each nomination and a recipient has been selected. Although your nominee was not selected, we appreciate receiving your nomination and encourage you to update the dossier and resubmit the nomination next year.

__________________      _____________________________________________
(date)                                 Selection Committee Chair