Award Nomination Form

Midcontinental Chapter of the Medical Library Association

This form is not interactive. Please fill it out and Print out the form and submit it with the supporting documents.

Award	Barbara McDowell Award Bernice M. Hetzner Award MCMLA Outstanding Achievement Award
Nominee:
Institution:
Address:
City:
State:
Zip:

Nominator:
Institution:
Address:
City:
State:
Zip:

Please send any documents in .PDF format. If you need help converting your document to .PDF, contact the Web Editor.
Checklist for Supporting Documents (Required)
MCMLA Member?
Nomination Form?
Description of nominee's qualifications by nominator?
Current one-two page Curriculum Vitae?
Letter(s) of Recommendation (at least one but no more than three)?

Mail Nomination Form and supporting documents to:

Darrel Willoughby
VA Medical Center
Medical Library 142D
4101 Woolworth Ave
Omaha, NE 68105

E-mail: darrel.willoughby@va.gov

Deadline for Nominations: July 1, 2007