Sample of Completed Nomination Form

Return Mailing Address: Must be typed and fit into the box below

John H. Doe Office of General Counsel Department of Energy 6th & D Sts, Washington, DC 21115	OLE USE ONLY
	ACCEPTED	NOT SELECTED	WAITING LIST

Course Name Civil Federal Practice	Course Date(s):  March 20-24, 2000 Course Location:  Columbia, SC
Nominee's Name:  John H. Doe E-mail Address:  jdoe@usdoe.gov	[X ] Attorney [ ] Non-Attorney Nominee's Title:  Trial Attorney
Office, Agency, or Department: Office of General Counsel, Department of Energy	Phone Number:  (202) 555-5555 Fax Number:  (202) 555-7777
1. How long has the nominee been a lawyer / non-lawyer / support staff (circle one)?  5 yrs 3 mos
2. How long has the nominee been a lawyer / non-lawyer / support staff (circle one) in this particular office?  2 yrs
3. What percentage of nominee's work involves the subject(s) of the course?  75%
4. Indicate the level of skill or knowledge nominee has in this area: [X ] Novice [ ] Intermediate [ ] Advanced
5. If nominee is being nominated for a trial advocacy course, please indicate the number of trials the nominee has participated in:   15   Civil   0   Criminal
6. List all OLE courses that the nominee has attended in the last three years? Advanced Employment Discrimination, June 8-10, 1999 Advanced Civil Pretrial Practice, Aug 24-27, 1999
7. Has the nominee been nominated for this course in the past and not accepted? [ ]No [X ]Yes, when?   Jan 98
8. If necessary, please indicate any special considerations:  Nominee works directly with AUSAs on civil cases
Nominating Official's Name and Signature:  Jane Smith		Title:  General Counsel
Phone Number:  (202) 555-5555 Fax Number:  (202) 555-0000	No. of Nominees Submitted                       3	Order of Preference of this Nominee:  1