*1.What is your name?(Required.)

2.What is the name of the person you are nominating (please note UAEA will only consider nominations of current UAEA members)

*3.Please describe why you believe this person is "exemplary" and deserves UAEA recognition(Required.)

4.Is there any other information we should consider when evaluating this person?

5.If you feel comfortable, please provide your email or phone number (if we need more information we may need to reach out)