Nomination Form

3/15/24, 2:37 PM

Modern Makers Nomination Form

Modern Makers Nomination Form
OMB Control Number: 0690-0038
Expiration Date: 7/31/2026
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 0690-0038.  Without this approval, we
could not conduct this survey/information collection.  Public reporting for this information
collection is estimated to be approximately 5 minutes, 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 at: 100 Bureau Drive, Stop 4700,
Gaithersburg, MD 20899 Attn: Education and Workforce Development Manager Brad
Conrad, brad.conrad@nist.gov
This form is being used to collect nominations for the next round of Manufacturing USA
Modern Makers. Modern Makers are individuals whose sense of purpose embodies the

https://docs.google.com/forms/d/e/1FAIpQLSf3aNnWZbCr9fG1zWniO8eiw81z19MNxdf1J_o_810xzxrrmQ/viewform

1/8

3/15/24, 2:37 PM

Modern Makers Nomination Form

Manufacturing USA mission to secure the future of U.S. manufacturing through innovation,
education, and collaboration. 
Please nominate individuals who are inspirational yet relatable: college students to
executives, who are at work in our ecosystem at manufacturing innovation institutes and
member companies. This can include those who may be in early career stages, those who
have transitioned within your organization, and those who have inspiring career
pathways.
By submitting this information, you are agreeing that the people listed can be contacted
using the provided contact information.
brad.conrad@nist.gov Switch account
Not shared
* Indicates required question

Nominator Information:
This information is only used in case we have questions about your submission, and we
need to reach out (not common).

Nominator name (First Last) *
Your answer

https://docs.google.com/forms/d/e/1FAIpQLSf3aNnWZbCr9fG1zWniO8eiw81z19MNxdf1J_o_810xzxrrmQ/viewform

2/8

3/15/24, 2:37 PM

Modern Makers Nomination Form

Nominator email *
Your answer

Nominee information:
This information will be used to evaluate nominations and, if they are selected, used to
help generate content about their career pathway.

Nominee name (First Last) *
Your answer

Nominee contact email *
Your answer

Optional: Nominee phone number
Your answer

https://docs.google.com/forms/d/e/1FAIpQLSf3aNnWZbCr9fG1zWniO8eiw81z19MNxdf1J_o_810xzxrrmQ/viewform

3/8

3/15/24, 2:37 PM

Modern Makers Nomination Form

Nominee job title *
Your answer

Nominee company/place of employment *
Your answer

How do you know the nominee? *
Your answer

Why are you nominating this person? *
Your answer

Why is the person you're nominating inspiring?  *
Your answer

https://docs.google.com/forms/d/e/1FAIpQLSf3aNnWZbCr9fG1zWniO8eiw81z19MNxdf1J_o_810xzxrrmQ/viewform

4/8

3/15/24, 2:37 PM

Modern Makers Nomination Form

Optional: Employer's website URL
Your answer

Optional: Brief bio or link to the nominee's bio (e.g., LinkedIn profile or company
profile)
Your answer

https://docs.google.com/forms/d/e/1FAIpQLSf3aNnWZbCr9fG1zWniO8eiw81z19MNxdf1J_o_810xzxrrmQ/viewform

5/8

3/15/24, 2:37 PM

Modern Makers Nomination Form

Privacy Act Statement
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to
inform you of why the U.S. Department of Commerce (the Department), National
Institute of Standards and Technology (NIST) is requesting the information on
this form. 
AUTHORITY:
The collection of this information is
authorized under The National Institute of Standards and Technology Act, as
amended, 15 U.S.C. 271 et seq. (which includes Title 15 U.S.C. 272 and 275) and
section 12 of the Stevenson-Wydler Technology Innovation Act of 1980, as amended, 15
U.S.C. 278s(d)(2)(A), as amended. https://uscode.house.gov/​view.xhtml?​req=​
(title:15%20section:278s%20edition:prelim).
PURPOSE:
NIST is collecting this information to support the nomination and selection process
of NIST's Manufacturing USA network program called Modern Makers. Modern
Makers are individuals whose sense of purpose embodies the Manufacturing USA
mission to secure the future of U.S. manufacturing through innovation,
education, and collaboration.
ROUTINE USES:
The information solicited on this form may be made available as a “routine use” pursuant
to 5 U.S.C. § 552a(a)(7) and (b)(3).  The information may be made available to other
federal agencies to assist the Department in connection with NIST’s management of the
purposes stated above; or for other authorized routine uses. A complete list of the routine
uses can be found in the system of records notice associated with this form,
“COMMERCE/DEPT-23: Information Collected Electronically in Connection with
Department of Commerce Activities, Events, and Programs.  This system of records notice
can be found on the Department's website
at https://www.osec.doc.gov/opog/privacyact/privacyact_sorns.html 
https://docs.google.com/forms/d/e/1FAIpQLSf3aNnWZbCr9fG1zWniO8eiw81z19MNxdf1J_o_810xzxrrmQ/viewform

6/8

3/15/24, 2:37 PM

Modern Makers Nomination Form

CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION:
Providing this information is voluntary.  However, failure to provide the requested
information may result in an inability for NIST to process, review, and/or act on such
requests.  In limited circumstances, NIST may authorize the submission of the requested
information via paper forms pursuant to the requirements in 15 CFR 748.1(d).

Submit

Clear form

Never submit passwords through Google Forms.
This form was created inside of National Institute of Standards and Technology. Report Abuse

 Forms

https://docs.google.com/forms/d/e/1FAIpQLSf3aNnWZbCr9fG1zWniO8eiw81z19MNxdf1J_o_810xzxrrmQ/viewform

7/8

3/15/24, 2:37 PM

Modern Makers Nomination Form

https://docs.google.com/forms/d/e/1FAIpQLSf3aNnWZbCr9fG1zWniO8eiw81z19MNxdf1J_o_810xzxrrmQ/viewform

8/8