NOMINATOR INFORMATION (Complete this section only if this is not a self-nomination and you are nominating another individual or group for this award)

Nominator Name:   

Business Title:       

Firm Name:             

Address:               

City:                       

State:                     

Zip:                        

Phone:                   

Fax:                       

Email:                    

Cell:                      

BASIC NOMINEE INFORMATION (This section must be completed and should contain information about the person or group who is being nominated for the award)

Nominee Name:    

Business Title:      

Firm Name:            

Address:              

City:                      

State:                   

Zip:                      

Phone:                 

Fax:                     

Email:                   

Cell:                     

Website:              

Clearing Broker/Dealer Name (if applicable):

Educational Background:

Credentials and Professional Designations Held:

Number of years serving employer-sponsored plans:

Number of plans you service:

Total number of participants you service:

Average plan retention rate (years):

Average plan size:        

Please indicate below what plan services you personally provide by checking the appropriate box and indicating the frequency with which you perform that service. If you perform none, please skip this section:
Enrollment Meetings                    Frequency
Performance Measurement        Frequency
Vendor Review                          Frequency
Business Planning                      Frequency
Investment Policy Statements     Frequency
Fee Review                                Frequency
Ongoing Participant Education    Frequency
Investment Advice                      Frequency
Service Contracts                      Frequency
Legal Advice                              Frequency

Awards & Recognitions received:

PART 2
Qualitative Commentary

Provide at least three (3) different and distinct examples of actual instances in which this candidate has made a direct impact upon individual participants, plan sponsors, retirement education or retirement investment products or strategy in the 401(k) industry.  Please be as descriptive as possible.

Provide any additional information you feel should be taken into consideration towards the nomination of this candidate for this Award.  Please be as specific as possible.

References   (please provide two)

Name:         
Firm Name: 
Address:    
Phone:        
Email:          

Name:         
Firm Name: 
Address:    
Phone:        
Email: