Congratulations! It is a tribute to your abilities and professionalism
to have been nominated for this prestigious state and national award.
Open to everyone regardless of affiliation or professional designation, candidates must:
• Be an insurance customer service representative, or have primary responsibility for customer service duties.
• Write an essay of no more than two pages double-spaced (approximately 1,000 words) on a topic to be
determined by The National Alliance.
• Submit letter(s) of recommendation from professional reference(s).
To complete your entrance into the competition, please complete this form and return it with your essay by
May 1, 2015. All essay entries become property of The National Alliance, inclusive of permission to reprint.
Candidate Information
(you may nominate yourself)
Please print or type.
Name
Designations (if any)
Years of experience
Current Job Title
Agency/Company
Address
City, State, Zip
Telephone
(
)
Fax
(
)
Email
References –
Two insurance business references are required (e.g., clients or industry colleagues)
1. Name
Agency/Company
Email
Address
City, State, Zip
Telephone
(
)
(
)
2. Name
Agency/Company
Email
Address
City, State, Zip
Telephone
Continued…
THIS AWARD IS SPONSORED BY THE NATIONAL ALLIANCE FOR INSURANCE EDUCATION & RESEARCH
2586-0115
|January-February 2015| KANSAS INSURANCE AGENT & BROKER
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