Copper Black Award nomination

The Copper Black Award is given to Mensans for specific creative achievements that have been demonstrated to be of practical value or for innovations that have been implemented, at least in part, to the advantage of persons other than the nominee. Achievements must have been demonstrated to be effective within the three calendar years preceding the award year to be considered. Self-nomination is encouraged!

Nominee Information (Mensa membership required)

*Mensa Membership ID:
*First Name:
*Last Name:
Address:
City:
State:
Postal Code:
*Email Address:
*Phone Number:
Nominated By: Self Other
 
 
Nominator Information (Mensa membership NOT required)

Mensa Membership ID:
*First Name:
*Last Name:
Address:
City:
State:
Postal Code:
*Email Address:
*Phone:
 
 
Accomplishment Information

Subject of the Accomplishment:
(In 300 words or less, describe the problem, difficulty, or other circumstances that is addressed by the creative achievement. Include how long the problem has persisted, if known.)
 
Description of the Accomplishment:
(Describe the achievement. Please do not exceed one page for this section. Clippings from periodicals, professional journal articles, or other documents that provide objective evidence of the problem, implementation, recognition, significance, etc., may be attached to support the nomination.)
 
 
File Attachments (allowed types include .pdf, .doc, .wpd, .rtf, .txt)
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