Pierre Jay Award Nomination Form

Nominee's Name *

Nominee's Organization *

Nominee's City & State *

Nominee's Email *

Nominee's Phone *

A. List or describe the contributions this nominee has made that have benefited the state credit union system significantly? *

B. Describe the nominee’s service, leadership and commitment to the state credit union system (or NASCUS), using examples. *

Nominator’s name *

Nominator’s organization (must be a NASCUS member)

Nominator’s city and state

Nominator’s email address

Nominator’s phone number