This document contains the Application Form and checklist for the 2022 Malcolm Baldrige National Quality Award. Before filling out the form, please read the Application Content and Format guidelines on our website [https://www.nist.gov/baldrige/application-content-and-format]. The form uses text fields ( ) that expand as you type. To enter text, place your cursor in the field, click to highlight the field, and begin typing. Use the Tab key to navigate to the next field. |
Paperwork Reduction Act Statement
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0693-0006. Without this approval, we could not conduct this information collection. Public reporting for this information collection is estimated to be approximately 74 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are voluntary. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the National Institute of Standards and Technology, Attn: Robert Fangmeyer, Director Baldrige Program, robert.fangmeyer@nist.gov.
OMB Control No. 0693-0006
Expiration Date: 07/31/2022
1. Your Organization
2. Award Category and Criteria Used
3. Official Contact PointDesignate a person with in-depth knowledge of the organization, a good understanding of the application, and the authority to answer inquiries and arrange a site visit, if necessary. Contact between the Baldrige Program and your organization is limited to this individual and the alternate official contact point. If this official contact point changes during the application process, please inform the program. ☐ Mr.☐ Mrs.☐ Ms.☐ Dr.
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4. Alternate Official Contact Point☐ Mr.☐ Mrs.☐ Ms.☐ Dr.
5. Release and Ethics StatementsRelease StatementI understand that this application will be reviewed by members of the Board of Examiners. If my organization is selected for a site visit, my organization will
If selected to receive an award, my organization will share nonproprietary information on its successful performance excellence strategies with other U.S. organizations. Ethics Statement and Signature of
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Signature |
Date |
☐ Mr. ☐ Mrs. ☐ Ms. ☐ Dr.
Printed name |
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Job title |
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Applicant name |
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Mailing address |
☐ Same as above
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Telephone |
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Indicate the amounts enclosed. (See the Baldrige Award Process Fees page on our website [https://www.nist.gov/baldrige/baldrige-award/award-process-fees].)
Application fee |
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Total |
$ 0.00 |
Indicate your method of payment.
☐Check ☐ Money order
Official Name of Organization:
Mailing Address:
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To pay by check or money order, please make payable to the Malcolm Baldrige National Quality Award and include the name of the organization applying on the memo line. Include one printed copy of this page with your payment. |
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☐ ACH payment ☐ Wire transfer Checking ABA routing number: 041000124 Checking account number: 4245714835 |
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Before sending an ACH payment or wire transfer, please notify the American Society for Quality by emailing: asqbaldrige@asq.org and gaustin@asq.org Please reference the Baldrige Award with your payment. |
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☐ Visa ☐ MasterCard ☐ American Express |
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Card number |
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Authorized signature |
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Expiration date |
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Printed name |
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Card billing address |
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Today’s date |
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Double-click on the PDF icon below to access ASQ’s W-9. Contact ASQ at (414) 765-7205 with questions.
Note: Do not include this page (page A-2 of the Application Form) in your 50-page PDF application file.
You must email asqbaldrige@asq.org to request a link to submit your application through NIST’s secure file transfer system.
☐ I have included my organization’s application as a printable PDF file
☐ The application meets all formatting requirements. (See Application Content and Format webpage and Details document)
The application contains the following sections, as well as divider pages indicated in Application Content and Format webpage and Details document:
☐ title page
☐ Table of Contents
☐ page A-1 of the 2022 Application Form
☐ date-stamped copy of the Eligibility Certification Form received from ASQ
☐ date-stamped copy of the organization chart(s) received from ASQ
☐ Glossary of Terms and Abbreviations
☐ Organizational Profile
☐ Responses Addressing All Criteria Items
☐ I have included one paper copy of page A-2 with my check or money order payment.
☐ I am paying by ACH payment or wire transfer and uploading page A-2 with my application package.
☐ I have indicated my method of payment for the application fee.
☐ If paying by check or money order, I have made it payable to the Malcolm Baldrige National Quality Award and mailed it to
Malcolm
Baldrige National Quality Award
c/o ASQ—Baldrige Award
Administration
600 North Plankinton Avenue
Milwaukee, WI
53203
(414) 765-7205
*Remember to include the name of the organization applying on the memo line.
☐ I am requesting a link to NIST’s secure file transfer system from asqbaldrige@asq.org and submitting the award application package no later than May 2, 2022 (PDF file only).
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 2022-09-19 |