THIS IS A SAMPLE FORMAT for an AFOS AWARD NOMINATION

COVER SHEET (One page- does not count toward 2 page max/please use 12 Font)

Nomination: (Junior OD, Senior OD, ORION)

Nominee:

Organization:

Rank:

Time in Service:

Duty Station:

Address:

Phone:

Email:

Nominated by:

Address:

Phone:

Email:

BULLET PAGES (2 pages max/minimum 10 font)

Present Title and Job Description:

Prior Duty Stations and Job Titles: (please list dates)

Memberships and Affiliations:

Federal Service Achievements in Optometry:

Other Professional Achievements:

Publications:

Lectures:

Public Service:

Previous Awards:

Miscellaneous:

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