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 fewer, 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, including the estimated number of people impacted. Please limit your answer to 500 words or fewer.

 
 

File Attachments (allowed types include .pdf, .doc, .wpd, .rtf, .txt)

Please include 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.

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