Criteria for Consideration

• Must be a member of RIMS
• Must be employed full-time in the insurance or risk management industry
• Demonstrates a commitment to professional continuing education
• Must meet the eligibility requirement to attend a CRM program

To nominate yourself or a colleague, please complete all of the blanks on this form.

Last Name

First Name

Agency

Address

City

State

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1. To what organization(s) does this individual belong (RIMS, PRIMA, etc.)?

2.What professional designations does this individual hold?

3. Has the nominee ever attended a CRM program?
yes no

4. Would the applicant give the necessary time to attend a course and continue toward the CRM designation?
yes no

5. Would the individual be able to attend without the fellowship?
yes no

6. May The National Alliance contact you for more information if necessary?
yes no

7. Please use the space below to give a brief description of the individual's work experience, commitment to professional advancement, or other reasons for consideration. Why does this individual want or need this fellowship? Explain why it is needed and how the nominee can give back to the industry.

Nominated By

Check to use information above

Last Name

First Name

Agency

Address

City

State

Zip

Phone

Email