Nomination

To be eligible for consideration, nominees must:

Have significantly impacted the insurance industry
Have an Iowa connection
Serve as a role model for young people and others in the industry
Exhibit the highest standards of ethical conduct
Have contributions to one’s community

Step 1 of 3

Nominee Contact Information

Name(Required)

First Last

Is the nominee deceased?(Required)

Yes

No

Who would accept the award if inducted?(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Day Phone(Required)

Cell Phone

Email(Required)

Nominee's Biographical Information

Please provide a summary of this nominee’s work history.(Required)

Please provide a summary of this nominee’s education.(Required)

Please provide any insurance industry specific information (including awards &/or other recognition).(Required)

Please provide a summary of this nominee’s community involvement.(Required)

If not obvious from the nominee’s biographical information, please provide a description of the nominee’s Iowa insurance industry connections.

Please describe how this nominee has served as a mentor and role model for young people and others in the insurance industry.(Required)

Documentation Section

In this section, please include information to support guideline considerations. You must include at least three letters of recommendation (One letter of recommendation can be from the nominator).(Required)

Drop files here or

Accepted file types: jpg, png, pdf, docx, csv, xls, xlsx, doc, Max. file size: 256 MB.

Nominator Contact Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Day Phone(Required)

Cell Phone(Required)

Email(Required)

Nomination Date(Required)

Please fill in today's date.

Comments

This field is for validation purposes and should be left unchanged.

Submit Nomination

Nominee Contact Information

Nominee's Biographical Information

Documentation Section

Nominator Contact Information

Induction Ceremony

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