NOMINATION FORM (Unclassified When Blank)

NOTES ON FILLING OUT THIS FORM:

• BE SPECIFIC (while observing classification rules). A description of the specific contributions of the nominee will make the nomination more competitive; maximize the amount of information about the candidate for the Selection Board without exceeding the page limit.
• Anonymous nominations will not be considered.
• If you complete this form in a nonsecure area, all information must be UNCLASSIFIED.
• Be sure to indicate at the top and bottom of this page the classification of your nomination.
• You must adhere to the word limit indicated for each category - your description of the nominee should not exceed one (single-spaced) typewritten page.
• If you have questions about this form or othe Pioneer Recognition Program, please contact the NRO Office of Policy's Center for the Study of National Reconnaissance at (703) 808-1209.
• Use the address below for UNCLASSIFIED MAILING ONLY. You must submit any classified nominations via secure channels.

TO: Director, National Reconnaissance Office
Attn: Executive Secretary, Pioneer Selection Board
14675 Lee Road
Chantilly, VA 20151-1715

NOMINEE INFORMATION

Nominee Name:
Served as (position):
In (program/activity):
Dates (period of major contribution described in Item #1, next page):
Dates (career in national reconnaissance):
Living/Deceased (if deceased, provide next-of-kin contact information):
If Deceased, Name of Next-of-Kin:
Street Address:
City, State, Zip:
Home Phone:
Work Phone:
Email:
Current Employer:

NOMINATOR INFORMATION

Nominator Name (REQUIRED):
Street Address:
City, State, Zip:
Email:
Current Employer:
Work Phone:
Home Phone:

Classification of this information (REQUIRED):

1) Specify the nominee's major contribution to national reconnaissance(about 25 words):

2) Describe how the nominee's contribution satisfies the selection criteria (about 150 words):

3) Explain the complexity of the national reconnaissance challenge and how the nominee uniquely contributed to meeting that challenge (about 150 words):

4) Summary of the record and reputation that this individual has in the discipline of national reconnaissance (about 70 words):

5) Suggest a paragraph for the Pioneer Medallion that would be displayed in Pioneer Hall if the nominee is selected (i.e., a summary of how the nominee changed the scope and direction of national reconnaissance) (about 80 words):