New Mexico Historic Preservation Division Department of Cultural Affairs 2015 HERITAGE PRESERVATION AWARDS NOMINATION FORM All nominations are considered equally. Those relating to the theme of cultural landscapes that inspired artists are encouraged. Section 1 Nominee (if joint nomination, please include names—limit to 4—and contact information for all nominees) Click here to enter text. Nominee’s address (include city, state, zip) Click here to enter text. Nominee’s daytime telephone with area code Click here to enter text. Nominee’s e-mail address and institutional affiliation Click here to enter text.

Section 2 Nominee’s State Representative and State Senator with mailing and e-mail addresses Click here to enter text. Nominee’s U.S. Representative; and Mayor or other local official with mailing and e-mail addresses Click here to enter text.

Section 3 This nomination is submitted by Click here to enter text. Address (include city, state, zip) Click here to enter text. Daytime telephone w/ area code Click here to enter text. E-mail address: Click here to enter text.

Section 4 I am nominating this individual(s)/organization(s) in the following award category (please check only one)  Lifetime Achievement State Historian’s Award for Excellence in New Mexico Heritage Scholarship Archaeological Heritage Architectural Heritage __ Urban Design within an Historic Context __ Citizen Advocacy “Rita Hill” Individual Achievement Heritage Organization Tribal Heritage Heritage Publication Community Preservation Planning

Section 5 Use the space below to describe in 300-500 words why this individual or organization is being nominated (see requirements). Click here to enter text.

Section 6 Use the space below to provide a 200-word biography of the nominee. This information will be required for a press release and presenter’s speech if your nominee is honored (see requirements). Click here to enter text.

Section 7 Do you know if this nominee has previously received a NM Heritage Preservation Award? Yes No Don’t know. If yes, please state year of award, category and project.

Return the completed form by March 12, 2015. Include 5 electronic photo files and one set of photo print-outs with completed nomination to: [email protected], or by mail to: HPD/Heritage Preservation Awards, 407 Galisteo St., Santa Fe, NM 87501. More forms and an explanation of categories are available at: www.nmhistoricpreservation.org. If you require assistance to complete this form, please call HPD at 505-827-4067.