Nomination For Bureau-Wide Awards

• Legal Form Number: BP-A0172
• Date: 2010-06
• Year: 2010
• Section: Federal Bureau of Prisons

BP-A0172NOMINATION FOR BUREAU-WIDE AWARDS CDFRM

JUN10

U.S. DEPARTMENT OF JUSTICEFEDERAL BUREAU OF PRISONS

AWARD TITLEAlpha/Numeric Code for Award

(i.e., A-1 = Sanford Bates Award)

Name (last, first, initial)

Title and Grade

Institution or Office

Social Security Number

(THIS SECTION TO BE USED ONLY FOR GROUP AWARDS)

NAMETITLE/GRADESSNDOLLAR AMOUNT

RECOMMENDED

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()YES()NO Did the nominee(s) for this award receive any other incentive awards for the same

accomplishments describe in this nomination? If yes, please attach a summary of the date, dollar

amount, and recognition previously received.

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Nomination submitted by (type name and signature)

Title

Regional Director/Branch Chief EndorsementDate

ATTACH A ONE PAGE JUSTIFICATION

PDF Prescribed by P3451This replaces BP-172(34) dtd July 1998