How to Submit A Nomination

To be eligible for consideration, nominees must have an Iowa connection, serve as a role model for young people as well as others in the insurance business, exhibit the highest standards of ethical conduct, and have significantly impacted the insurance industry.

You may fill up the form below to submit your nomination to be considered in the current selection cycle. The deadline to submit nomination is July 1, 2021. New nominations not selected in the current cycle will be remain eligible for five years.

Step 1 of 3

Nominee Contact Information

Name(Required)

First Last

Address

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

Day Phone

Cell Phone

Is the nominee deceased?(Required)

Yes

If so, who would accept the award if inducted?

Nominee Biographical Information(Required)

Summary of contributions to the insurance industry and community.(Required)

Other documentation to support guideline considerations, including letters of recommendation.(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)

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

How to Submit A Nomination

Nominee Contact Information

Nominator Contact Information

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Nominee Contact Information

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