Get documents about "mlea nomination and award order form
Document Sample
Please include name(s) and member number(s)
Member for each recipient below. Names should be
Leader listed as you would like them to appear on the
award.
Excellence
If this is a team award, please list the team
Award name as it should appear on the award and year
of service.
Use this award
for recognition of Shipping and handling charges apply to each
Member Leaders award ordered in the following amounts:
Recognize member Quantity U.S. Canada Others
individuals or teams for 1 $6.50 $11.50 $14.75
their outstanding 2 $12.50 $17.50 $29.50
commitment to ASQ and
Inscription:
their communities
In recognition of your commitment
and outstanding contributions to your
ASQ section and your community
(Size 4-1/4 inches x 7-1/4 inches)
Name Number
SECTION
Ordering Name Number
MEMBER
Address
SHIPPING
City State/Prov. Zip/Postal Code
ADDRESS
Item number Quantity Cost per item Total
R104 N $59 plus s/h (above)
MC/Visa AMEX Number Exp. Date
PAYMENT Purchase order Number
Check
Name/Team Member Number
AWARD WINNER Member Status
Name/Team Member Number
AWARD WINNER Member Status
Limit of two awards per Member Unit each fiscal year.
Awards will be shipped 30 days after order is received. Date Needed
Mail E-mail Fax
SUBMIT TO: ASQ
Along with MLEA Community Development
application form 414-765-8670
600 N. Plankinton Ave. communitydevelopment@asq.org
Milwaukee, WI 53201
All orders received by February 28th will be included in the Honors and Awards Brochure at WCQI.
Member Leader Excellence Award
Section Nomination Form
Each section may award two (2) Member Leader Excellence Awards annually. Recipients of the MLEA may be individuals or
teams. An award issued to a team is one award, even if multiple recipients will receive the plaque. Complete one form for each
individual or team being awarded.
I. Nominee Information
Individual name: Team name:
If this MLEA is for a team, list names of team
members:
II. MLEA Criteria.
a. Membership. Candidate must currently be, or had been, a Regular Member of the Society and member unit
presenting award during frame being recognized. Regular Members are:
Designated Representative
Member Senior Fellow Honorary of Sustaining Member
b. Award criteria. Candidates should be rated on a scale of zero to five for each of the following criteria, with five
being exceptional and long term contribution, zero being no contribution in that category. A candidate must meet a
minimum score of 12 to qualify for this award.
Score Criteria
Participation in educational activities at the local level. This includes courses taught at colleges and
universities and to industry, courses taught for the member unit, papers presented at local conferences,
section meetings, etc.
Participation in educational activities at the regional, national, or international level. This includes HQ-
sponsored courses taught, papers presented at regional, national, or international conferences, etc.
Promotion of quality activities at local level. This includes participation in section, council, alliance or
division activities as an elected officer, committee chair or participation in state quality award programs,
etc.
Promotion of quality activities at the regional, national, or international level. This includes participation
in an elected or appointed ASQ office at the regional, national, or international level, or participation on
national quality awards programs, etc.
III. Section Information:
Section Name Section Number
Submit this form, along with the MLEA order form to: ASQ Community Development, P.O. Box 3005,
Milwaukee, WI 53201-3005; fax: 414-765-8670; email: communitydevelopment@asq.org
