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APPENDIX I
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: |
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| 2) |
Name(s) of person(s) making the nomination: |
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a) |
Address of person(s) making the nomination: |
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b) |
Telephone number of person(s) making the nomination: |
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3)
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A description of how the outcome, achievement or savings |
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a) |
exceeds normal expectations for the employee/student,
or group of employees/students; OR |
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b) |
has an impact on the delivery of services to the public
or other so-called "customers" of MSU-Northern; OR |
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c) |
contributes, directly and to what degree, to MSU-Northern's
objectives, goals and mission. |
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| 4) |
The dollar value of the documented savings: |
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| 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):
Return to Policy 850.3
Return to Section 800
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P.O.
Box 7751