First and Last Name

Please include the mailing address, phone number, and email.

Please describe in detail why you feel the nominee should receive the award, including information about the duration of their support of intellectual freedom, the description of any specific incidents, or description of moral, financial, or professional support from organizations or community members.

Indicate two individuals who might be contacted to provide supportive evidence for this nomination.

Their contact information: name, organization, position, mailing address, phone number, and email.

Please Include your contact information: name, organization, position, mailing address, phone number, email, and website.

Is this a self nomination?