Online Contact Form

Full name:

Address:

Daytime phone number of the individual:

Email address of the individual:

His/her tribal affiliation:

Name and address of Organization through which he/she conducts community work:

Phone number of Organization:

Category of work

Nominations for individuals from both the public and private sectors are eligible.  (check one)

• Volunteer -- Individuals whose efforts are a voluntary expression of good citizenship.
  
• Professional -- Individuals who are career professionals, either currently employed or retired from the conservation field, or band- or tribally-based natural resource or conservation fields.
  
• Nonprofit Organizations and Public Agencies -- Individuals who work in private sector organizations or public agencies.
  

Documentation

Please list all documents included in the nomination packet of the candidate's conservation activities (e.g., dvd, cd, tribal resolutions of support, newspaper and magazine articles). A resumé or Curriculum Vita is encouraged. You may send scans, text documents, or pdf's, electronically to or by fax 503-222-1517, or mail the hard copy.

Document list:

References who are familiar with the nominee's work.

Please ask these individuals to supply an additional letter of recommendation, using the same format as the nominator's letter. This will strengthen the candidate's nomination considerably.

Reference One:

Name:

Relationship:

Phone number:

Email address:

Mailing address:

Reference Two:
Name:

Relationship:

Phone number:

Email address:

Mailing address:

Nominator

Name:

Address:

Daytime phone number (required):

E-mail address: