Chairman's Safety Award Application

Nominee Name*

First NameLast Name

Submitted By*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Explain why your nominee should receive the MSI Fellow Award*

Criteria Information:

Criteria: Active experience in Workforce Development for manufacturing

Minimum Requirement: Five years of working in workforce solutions in manufacturing or in support of manufacturing workforce solutions

Example of write-up: 3/1/2012 – 2/15/2018 worked in workforce development office of XYZ company and taught pre- apprenticeship courses at Local Community College

Evidence of Attainment: Resume with detailed job descriptions

Criteria: Active Support for one or MSI related Credentials or services prior to applying for MSI Fellow

Minimum Requirement: Supported the attainment of at least one of the MSI certificates or credentials, e.g. MS, MT1, ChemTech, ISRT, Craft Brewer Quality and Safety Certificate, World Class Manufacturing, etc.

Example of write-up: J. Q. Doe has been HR director for XYZ company for 15 years and used the MT1 as part of the Pre-Apprenticeship program.

Evidence of Attainment: Certificates of achievement or credential or letter signed by supervisor

Criteria: Has attained distinction in manufacturing related disciplines

Minimum Requirement:

Attained distinction in one or more of the following ways:

Planning or scheduling workforce related activities
Teaching one or more manufacturing related disciplines or credentials at a school, agency or company
Developing original theories, principles or disciplines in a workforce related field
Expounding useful theories, principles or disciplines in a workforce related field
Directing work of significant scope in the application of workforce development

Example of write-up:

J.Q. Doe developed and planned the rollout of the workforce credential program at XYZ School
J.Q. Doe has taught the pre-apprenticeship class at XYZ Company for three years from 1/3/2014 through 5/2/2016
J.Q. Doe published the paper titled, XYZ in Workforce, in ZYX publication.
J.Q. Doe is a regular speaker on workforce at blank venue and is speaking at blank.
J.Q. Doe has been the Corporate VP of HR and Workforce at XYZ Co. or school system

Evidence of Attainment: Job descriptions, resumes, letters of commendation, copies of records of service (teaching or speaking).

I acknowledge by clicking the submit button that all information above is true to the best of my knowledge.

MSI Fellow Submission