iron mike award for volunteer service nomination form - Fort Bragg
iron mike award for volunteer service nomination form - Fort Bragg
iron mike award for volunteer service nomination form - Fort Bragg
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IRON MIKE AWARD FOR VOLUNTEER SERVICE NOMINATION FORM<br />
(UPDATED 2/20/06)<br />
Please read carefully and complete all required in<strong>for</strong>mation. Incomplete <strong>nomination</strong> <strong>for</strong>ms will<br />
automatically be disapproved and returned to the nominating official.<br />
Please indicate the type of <strong>award</strong> <strong>for</strong> which the individual is being nominated:<br />
____ Iron Mike Lapel Pin ____ Bronze Star ____ Silver Star ____ Gold Star<br />
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PART I – Nominee In<strong>for</strong>mation - To Be Completed By Nominating Individual (can<br />
be anyone with knowledge of <strong>volunteer</strong> <strong>service</strong> per<strong>for</strong>med)<br />
NAME OF NOMINEE __________________________________________________________<br />
NOMINEE ORGANIZATION/UNIT ________________________________________________<br />
ADDRESS ___________________________________________________________________<br />
CITY ______________________________ STATE ________ ZIP CODE ________________<br />
NAME OF NOMINATOR ________________________________________________________<br />
VOLUNTEER ORGANIZATION/UNIT ______________________________________________<br />
NOMINATOR PHONE NUMBER _________________________________________________<br />
NOMINATOR E-MAIL ADDRESS _________________________________________________<br />
---------------------------------------------------------------------------------------------------------------------<br />
PART II – NOMINATION APPROVAL (Organization Director or O-6 Commander/<br />
CSM or above in chain of command). SIGNATURE VERIFIES NOMINATION<br />
INFORMATION ONLY AND DOES NOT SIGNIFY APPROVAL OF AWARD.<br />
NAME ______________________________________________RANK___________________<br />
ORGANIZATION/UNIT _________________________________________________________<br />
SIGNATURE (required) ________________________________________________________<br />
---------------------------------------------------------------------------------------------------------------------<br />
PART III – Justification – To Be Completed By Nominating Individual.<br />
1. Please indicate dates <strong>for</strong> which <strong>nomination</strong> is being submitted (MUST BE THE<br />
CURRENT QUARTER in which <strong>nomination</strong>s are being accepted):<br />
From: ____________________ To: ____________________<br />
PLEASE TURN TO PAGE 2
2. Please answer each of the following in as much detail as possible. You may<br />
use paragraph or bullet <strong>for</strong>mat and may use an additional page if necessary. ALL<br />
3 QUESTIONS MUST BE ADDRESSED.<br />
a. List specific contribution(s) made by the <strong>volunteer</strong> TO YOUR ORGANIZATION/UNIT<br />
during the period listed.<br />
PLEASE TURN TO PAGE 3
. How did this <strong>volunteer</strong> improve the quality of life <strong>for</strong> your organization/unit and/or <strong>for</strong><br />
the entire military community?<br />
c. Please list any <strong>award</strong>s/recognition the <strong>volunteer</strong> has received from your organization/<br />
unit over the past one year.<br />
_______________________________________ _____________________________<br />
Signature of Individual Writing Nomination Date<br />
PLEASE TURN TO PAGE 4
3. This <strong>nomination</strong> will be reviewed by the Installation Volunteer Awards Review<br />
Committee and approval/disapproval will be based on a subjective review of the<br />
written justification compared to the established criteria.<br />
4. Please verify registration and hour documentation in<strong>for</strong>mation on this<br />
<strong>volunteer</strong> PRIOR to submission of this <strong>nomination</strong>. Incomplete <strong>nomination</strong> <strong>for</strong>ms<br />
or registration/ documentation in<strong>for</strong>mation will result in disapproval and will be<br />
returned without action.<br />
5. PLEASE FORWARD TO: INSTALLATION VOLUNTEER SERVICES<br />
IMSE-BRG-MWA-V<br />
BUILDING 1-3571 (COMMUNITY CENTER)<br />
FORT BRAGG, NC 28310<br />
---------------------------------------------------------------------------------------------------------------------<br />
PART III – To be completed by the Installation Volunteer Services office<br />
Date Received ________________________________________________________________<br />
Volunteer Registration Date _____________________________________________________<br />
Documented Hours (beginning 1 October 2000) _____________________________________<br />
Approved ___________ Disapproved (Explain) ______________________________________<br />
____________________________________________________________________________<br />
Date Returned to Nominator______________________________________________________<br />
Date Award to be Presented _____________________________________________________<br />
Previous Iron Mike Awards Received ______ Pin ______ Bronze ______ Silver _____ Gold<br />
AVCC Signature ______________________________________________________________<br />
Date ________________________________________________________________________<br />
Privacy Act Statement: Prescribing Directive: AR 608-1. Authority: Title 10, USC, Section 3012. Principal Purpose: To record<br />
essential in<strong>for</strong>mation on <strong>volunteer</strong>s. Routine Uses: Coordinating <strong>volunteer</strong> <strong>service</strong>s at <strong>Fort</strong> <strong>Bragg</strong>, NC, recruiting <strong>volunteer</strong>s and<br />
planning <strong>volunteer</strong> <strong>award</strong>s programs. Mandatory or <strong>volunteer</strong> disclosure and effect on individual not providing in<strong>for</strong>mation:<br />
Providing in<strong>for</strong>mation is voluntary. Not providing in<strong>for</strong>mation will prevent keeping a record of individual <strong>volunteer</strong> qualifications and<br />
<strong>service</strong>s and may prevent <strong>volunteer</strong>s from receiving <strong>award</strong>s.
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