2023 G & S Circle Nom. Form

    Candidate Name:

    Street Address

    City/Town:

    State:

    Zip Code:

    Phone Number:

    Email Address:

    Date & Place of First Employment:

    Present Occupation & Title:

    Gold or Silver Candidate?:

    Community Contributions:

    List any associations or volunteer work.

    Teaching or Educational Training Experience:

    Nominated by:

    Street Address

    City/Town:

    State:

    Zip Code:

    Phone Number:

    Email Address:

    Nominator's Recommendation:

    Please state in your own words, the reasons this person should be inducted into the Gold or Silver Circle.

    Attach Supporting Material: should include but not limited to; resume, letters from colleagues, community leaders or others who can speak to the candidates impact on the television industry and/or their community.

    File types accepted for uploads are: .doc, .docx, and .pdf

    Final Review: Please review information on the form the before checking the accept box.

    ACCEPT