2022 SEAFC Fire Chief of the Year Nomination Form – Southeastern Association of Fire Chiefs

Deadline: March 31, 2022 at 11:59 PM CST (Midnight)

1. Nominator Information

Nominating Organization or Association: *

If you are not with an organization please type -- Individual.

Nominating Organization Contact Name: *

First

Last

Nominator's Title: *

Nominator's Email Address: *

Nominator's Mailing Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Nominator's Phone Number: *

2. Nominee Information

Nominee Contact Name: *

First

Last

Nominee Title: *

Nominee Mailing Address: *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Nominee's Phone Number: *

Is Nominee An IAFC Member?

Yes
No
Not Sure

Award Category: *

Career - position is primary source of income with combination or career department
Volunteer - position is not primary source of income for volunteer or combination department

3: Nominator Supporting Documents

Nominator Statement *

Describe why you are nominating this individual. (Limit 1000 Words)

Resume

Click or drag a file to this area to upload.

Accepted file types: .doc, .pdf, .docx Maximum 5MB

Recommendation 1

Click or drag a file to this area to upload.

Accepted file types: .doc, .pdf, .docx Maximum 2MB

Recommendation 2

Click or drag a file to this area to upload.

Accepted file types: .doc, .pdf, .docx Maximum 2MB

4. Submission

Please provide your full name below, thus certifying that all of the information in this application is correct to the best of your knowledge. Two awards will be presented in Mobile, AL at the Renaissance Riverview Plaza on June 23, 2022; one for a career fire chief and one for a volunteer fire chief.

Name *

First

Last

Email Address (if person submitting IS NOT the nominator)