Section 800: Financial Affairs

Effective: January 7, 2003

Nomination Form for
The Employee/Student Incentive Award Program
At Montana State University-Northern
Return to Policy 850.3

PLEASE NOTE: An incomplete nomination form may be returned to the submitter(s) for additional information. Therefore, the information requested on this form should be provided as completely and accurately as possible.

  1. Name(s) of person(s) being nominated for the award:

  2. Name(s) of person(s) making the nomination:

    1. Address of person(s) making the nomination:

    2. Telephone number of person(s) making the nomination:

  3. A description of how the outcome, achievement or savings
    1. exceeds normal expectations for the employee/student, or group of employees/students; OR
    2. has an impact on the delivery of services to the public or other so-called "customers" of MSU-Northern; OR
    3. contributes, directly and to what degree, to MSU-Northern's objectives, goals and mission.

  4. The dollar value of the documented savings:

  5. Information or documentation on the method used to determine the dollar value in part 4). The information or documentation may be attached to this form, but that should be noted in the space provided below.



Signature of submitter(s):
Date prepared by the submitter(s):