National OPSEC Awards

Submission Form

please type or print

Award Category: Check one and fill out completely

0  Organizational Achievement Award

Name of Nominated Organization:   ____________________________________________________

Organization Head (Mr./Mrs./Ms./Military Rank):   _________________________________________

Mailing Address:   __________________________________________________________________

City, State, ZIP Code:   ______________________________________________________________

Phone: (___) __________________ FAX: (___)____________________________________

0 Individual Achievement Award

Name of Nominee (Mr./Mrs./Ms./Military Rank):   _________________________________________

Organization:   _____________________________________________________________________

Organization Head (Mr./Mrs./Ms./Military Rank):   _________________________________________

Mailing Address:   __________________________________________________________________

City, State, ZIP Code:   ______________________________________________________________

Phone: (___)__________________ FAX: (___)____________________________________

0 Multimedia Achievement Award

0 Electronic

0 Print

Title of Nominated Product:   __________________________________________________________

Name of Product Developer (Organization/Team/Mr./Mrs./Ms./Military Rank):   ________________

  __________________________________________________________________________________

Organization:   _____________________________________________________________________

Organization Head (Mr./Mrs./Ms./Military Rank):   _________________________________________

Mailing Address:   __________________________________________________________________

City, State, ZIP Code:   ______________________________________________________________

Phone: (___)__________________ FAX: (___)____________________________________

Point of Contact for Submission :

Name (Mr./Mrs./Ms./Military Rank):   ____________________________________________________

Mailing Address:   __________________________________________________________________

City, State, ZIP Code:   ______________________________________________________________

Phone: (___)__________________ FAX: (___)____________________________________

E-mail Address:   ___________________________________________________________________

Supervisor/Manager Certification :

I certify that the information provided in the accompanying submission package for the National OPSEC Award was completed during the past fiscal year.

Name (Mr./Mrs./Ms./Military Rank):   ___________________________________________________

Title/Organization:   _________________________________________________________________