FLICC Librarian of the Year Award Nomination Form

This is not an interactive Web form.
Fill out, then print and get required endorsements and signatures;
mail or fax. See instructions below.

NOMINEE (PLEASE PRINT):

Name:
Title:
Library:
Library Address:
City:
State:      Zip:  
Phone:
Fax:
Email:

NOMINATOR:

Name:
Title:
Organization:
Address:
City:
State:      Zip:  
Phone:
Fax:
Email:
Nomination statement (mandatory): I believe the nominee should be
Federal Librarian of the Year because (50 words or less)
_________________________________________________________________________
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Signature:      Date:    

MANAGEMENT APPROVAL:

Statement of approval: I approve this nomination for
Federal Librarian of the Year.
Comment:__________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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IMMEDIATE SUPERVISOR'S SIGNATURE:

Signature:      Date:    
Name:
Title:
Organization:

SECOND LEVEL MANAGER'S SIGNATURE:

Signature:      Date:    
Name:
Title:
Organization:
INSTRUCTIONS:
Deadlines: DEADLINE EXTENDED TO DECEMBER 14, 2001!!! [To avoid mail delays, this year FLICC is accepting a fax copy of the nomination form. The complete nomination package, with the form and any attachments, must also bear a postmark of December 14, 2001. ] Mail them to the Federal Library and Information Center Committee (FLICC), c/o Library of Congress, LA-217, 101 Independence Avenue, SE, Washington, DC 20540-4935, or fax them to (202) 707-4818.
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