An institution can nominate anyone they want for a coaching or athlete USTFCCCA Regional award. They can only nominate one per category. From there nominations are voted on. All USTFCCCA member coaches have a vote.
Whoever wins the vote wins the award, and goes up for the National Level award, which is again voted on by member coaches.
Most every NCAA coach is a member. I have no idea what percent actually participates in the vote.
Conference awards will have a similar process, most likely, but that is handled by the conference office.
Generally speaking Conference, Regional and National awards are a big deal; especially for DI schools. Many coaches qualify for bouses or have contract negotiating leverage for winning these awards.
The exception to this may be those schools/coaches in conferences they regularly dominate (Furman in SOCON XC or Iona in MAAC XC). Probably not a big deal for those schools coaches to win a conference level award they have won 10 times over.