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New York State Association of Professional Land Surveyors
PILLARS OF EXCELLENCE AWARDS PROGRAM

Nomination Form

Please check the appropriate category for this nomination. A separate nomination form must be used for each entry.
You may photocopy this for additional entries.
 NYSAPLS Meritorious Service Award
 Surveyor of the Year Award
 NYSAPLS Associate of the Year Award
 Lifetime Achievement Award
 Friend of the Association Award
Contact Person (submitting nomination): _____________________________________________________________________
Regional: ______________________________________________________________________________________________
Tel: ___________________________________ E-mail: ________________________________________________________
Address: _______________________________________________________________________________________________
City: _____________________________________________________________ State: __________ Zip: ________________
Nominee Name: _________________________________________________________________________________________
Tel: ___________________________________ E-mail: ________________________________________________________
Address: _______________________________________________________________________________________________
City: _____________________________________________________________ State: __________ Zip: ________________

Professional Experience: Use additional paper if necessary
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Education and Training
School/College Location Year Major Degree

Surveying Industry Involvement: Please describe briefly
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Awards, Scholarships, Academic Achievements: Please list below
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Community Involvement
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Local Regional Honors
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Nomination forms should be sent by December 15, 2023 to NYSAPLS; 146 Washington Avenue; Albany, NY 12210.
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