Name of Nominee:

Title:

Name of Institution:

APPA Fellow Checklist

Graduation Date from APPAs Institute for Facilities Management
Upload a scan of your graduation certificate below or send a copy to John Bernhards at APPA: fax 703-549-2772 or mail 1643 Prince St. Alexandria, VA 22314

Graduation Date from APPA Leadership Academy
Upload a scan of your graduation certificate below or send a copy to John Bernhards at APPA: fax 703-549-2772 or mail 1643 Prince St. Alexandria, VA 22314

CFar Research Project Title:

Title of article published by APPA:

Publish/To-be Published Date:

Presentation of research at an APPA or other higher education or facilities management organization conference is encouraged but not required.

Have you presented the research at an APPA or other higher education or facilities management organization conference?
No Yes

Two references from colleagues in the educational facilities profession that speak about the your successes and dedication to the educational facilities profession are required for your application. Please provide the name, title, institution email address and phone number of two people that you wish to use as a reference. They will be notified by email to complete their reference online.

Submitted by:

Title:

Institution:

Address:

City:

State:

Zip:

Telephone:

Fax:

E-mail:

Public relations or media relations contact:

In order to complete the submission process, please check off your regional A&R Committee Member listed below:
Eastern: Joe Rubertone, Quinnipiac University
Southeastern: Elizabeth Sisk, University of Memphis
Midwestern: Ernie McVay, Ohio State University
Rocky Mountain: Jeff Butler, University of Montana
Central: Art Jones, Black Hills State University
Pacific: Anthony Guerrero, University of Washington/Bothell

Thank you for your submission.