Nominations

*Required Fields

To Nominate An Individual . . .

 

*School:	Select below k-5 Middle High
*School Name:
*Name:
*Address:
*City: *State: *Zip:
*Phone:	(Please do not add dashes, periods)
*Email:
Grade:
# of hours:
Age:
ORGANIZATION: (Name of organization for which individual volunteers)
*Organization:
Org. Phone:
Contact Person:
NOMINATOR:
Name:
Address:
City: State: Zip:
Phone:
Email:
Activity: Describe nominee's volunteer service(s)
Need: Describe need for nominee's service(s)
Time: Number of hours nominee has volunteered for organization.
Achievement: Did nominee accomplish desired results? Explain.
Impact: Describe impact or difference nominee's service made to the community. How many people were affected?
Challenges: Did nominee overcome challenges (physical or mental handicaps, limited resources, public perception)?
Other: Why do you believe your nominee deserves the Service Above Self Award?
Please print a copy of the completed form for your records before clicking the submit button. Thank You.