Texas Medal of Arts Awards Nomination Form

PERSON/ORGANIZATION SUBMITTING NOMINATION:*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

NOMINEE INFORMATION*

First Last

Nominee Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nominee Email

Nominee Phone

Alternate Phone

Alternate Name

First Last

Title for Alternate Name

Email Address if Different from Above

Individual Nominee Birth Date

Individual Nominee Place of Birth

City State ZIP Code

Individual Nominee Years Spent in Texas

Please enter a number from 0 to 110.

Nominee Category

Category: Other (please elaborate)

For All Nominations*

Please summarize the following information in the space provided below. Supplemental materials may be emailed to tmaa@txculturaltrust.org but are not necessary. • Key professional credits, accomplishments, and/or highlights. • For Individual and Organization Arts Patrons, describe the arts or creative projects and organizations supported by the nominee.

2021 TMAA Nomination Form