Submit Nomination Online | Arkansas Insurance Hall Of Fame

"*" indicates required fields

1Step 1

2Step 2

3Step 3

YOUR NAME & CONTACT DETAILS:

You may be contacted by the AIHF Board for more information.

Your Full Name*

First Last

Company Name*

Email Address*

Your Phone Number*

YOUR CHOSEN NOMINEE’S DETAILS:

This information will not be shared outside of the AIHF Board.

Name of Individual You Are Nominating*

First Last

Is Your Nominee Living or Deceased*

Living

Deceased

Nominee Details:

Email Address of Nominee*

Phone Number of Nominee*

Company Name Nominee Represents*

Address Of Nominee*

Street Address City State ZIP Code

Deceased Nominee Details:

Closest Relative Contact Information*

First Last

Relative's Phone Number*

Relative's Email Address*

Hometown of Nominee*

City State ZIP Code

In-Depth Nominee Details*

Provide a chronological list of professional work history, including companies and positions held by year. Provide examples of excellence, such as the nominee’s professional accomplishments. It is recommended that nomination form details cover at least the past ten years.

Degree, Certificates, and Designations (by year)*

You may provide education and awards the nominee has earned or received.

Note: Please include contributions from at least the past 10 years. This should include no less than three to five significant accomplishments.

Professional Association Memberships, Affiliations, and Involvement*

These should be related to the industry in which the nominee is employed. Please note that nominees may be employed by organizations that have significant impact on the insurance industry.

Professional Excellence Contributions in the Workplace*

This includes leadership opportunities in the workplace and professional development of others such as mentorship.

Professional Achievements for the Industry*

Examples include innovations in products, services, and solutions or lasting contributions to advance the role of insurance in society.

Community Service*

This may include military, civic, church, and charitable contributions that significantly impact the lives of many Arkansans.

Brief statement of why this candidate deserves the honor.*

Arkansas Insurance Hall of Fame seeks to identify and honor distinguished insurance industry professionals who exemplify innovation in social responsibility, leadership and professional excellence and who have significantly impacted the lives of many Arkansans.

UPLOAD Supporting Documents in A SINGLE PDF File:

Accepted file types: pdf, Max. file size: 10 MB.

(Note: Uploads are optional and not required)

FORM SECURITY

Comments

This field is for validation purposes and should be left unchanged.