2018 Hall of Fame Application for Candidacy

Thank you for taking the time to nominate a worthy candidate for Bellwether recognition. We appreciate and welcome your insights about this professional. Please note that ONLY the Bellwether League Board of Directors will have access to this document and its content, which will remain strictly CONFIDENTIAL.

The Board of Directors evaluates the achievements and contributions of each candidate based on the content of his or her submitted nomination using criteria that can be found on Bellwether League’s web site. The Board of Directors recommends you review that document prior to completion of this application. The criteria include the following factors/parameters:

Leadership • Innovation/Creativity • Overall Work Performance • Strategic Thinking • Ethics/Integrity/Reputation • Supply Chain Advocacy • Mentoring • Value Analysis • Advancing the Art and Science of Supply Chain Management through Education, Research, Writing, Presentations, etc.

CANDIDATE NAME: ______

1. As NOMINATOR/SUBMITTER, please provide the following information about you:

First Name: ______

Last Name: ______

Title: ______

Company Name: ______

Email Address: ______

Phone Number: ______

Mobile Phone: ______2. CANDIDATE Status (please check one) [ ] Active [ ] Retired [ ] Deceased

3. Please provide the following required information about the CANDIDATE you are nominating.

First Name: ______

Last Name: ______

Title: ______

Company Name: ______

Company Street Address (Home Address if retired): ______

______

City, State, ZIP: ______

Email Address: ______

Phone Number: ______

Mobile Phone Number: ______

4. If deceased, please provide contact information for a Spouse, Child or Significant Other:

First Name: ______

Last Name: ______

Street Address: ______

City, State, ZIP: ______

Email Address: ______Phone Number: ______

Mobile Phone Number: ______

5. Please tell us the number of years the CANDIDATE did/has serve (d) in supply chain management in healthcare: ______; in other industries (if applicable): ______

Please complete this Nomination Form (questions 6-11) using detailed bullet points, phrases and/or sentences/paragraphs. Attach additional pages if needed. NOTE that the responses you provide in questions 6-11 should include “quantitative evidence/ outcomes”, achieved as a result of the candidate’s efforts, contributions and/or leadership role.

6. Please list and describe 3-5 specific examples of what this CANDIDATE accomplished or contributed, over his/her entire career, at a “Hall of Fame” level (as compared to a single season or initiative at an “All Star” level) that would be considered innovative, leading edge or pioneering. Please include but distinguish any healthcare contributions from those in other industries (if applicable).

7. Please share your opinions about this CANDIDATE’s capabilities in and contributions through mentoring, education, and/or advocacy to advance other supply chain professionals and executives, and the profession as a whole. (For example, this may include writing in various media outlets, participating in and speaking at various professional association and organizational events). 8. Please provide SPECIFIC EXAMPLES of how the CANDIDATE clearly demonstrated his or her leadership in healthcare organizations (including hospitals, consulting firms, suppliers, GPOs, etc.), and/or in other industries, charitable organizations, voluntary or professional organizations (if applicable).

9. Please provide SPECIFIC EXAMPLES of how the CANDIDATE clearly demonstrated innovation in healthcare organizations (including hospitals, consulting firms, suppliers, GPOs, etc.), and/or in other industries, charitable organizations, voluntary or professional organizations (if applicable).

10. Please provide SPECIFIC EXAMPLES of how the CANDIDATE clearly demonstrated his or her ability to facilitate and manage professional relationships and services with clients/customers outside of his or her department/designated/direct area(s) (including hospitals, consulting firms, suppliers, GPOs, etc.), and/or in other industries, charitable organizations, voluntary or professional organizations (if applicable). 11. Please provide examples of how the CANDIDATE demonstrated unquestionable ethics, moral standards and integrity.

In submitting this application, and based on my direct knowledge of this CANDIDATE, I hereby represent to Bellwether League that this CANDIDATE consistently meets the highest ethical standards of the profession.

______(Your Signature)

Please provide the name (s) and contact information of two others who can confirm your assessment of this CANDIDATE.

Please email this form, a brief biography and a CV/résumé of the CANDIDATE to [email protected]. Make sure the CV/résumé does not exceed 5 pages and includes a chronological listing of positions held, employers, college education and professional development, etc.

Thank You!