Stapenning nomination

I nominate the following person to be awarded the Stapenning honorary medallion:

Name

Position

Works for

The reasons why this person deserves a Stapenning honorary medallion (you may enclose your motivation in the form of a letter)

If applicable, add an annex

Concrete examples why the person is deserving of the medallion

If applicable, add an annex

Date envisaged for the presentation of the Stapenning honorary medallion (dd-mm-jjjj)

The following three staff members support this nomination. (Please enclose the signed letters of support.)

First supporter

Enclose letter of support

Second supporter

Enclose letter of support

Third supporter

Enclose letter of support

Nomination submitted by:

Name of submitter

Email address of submitter

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