Community Service Award Nomination Form
Nominate an individual or group who has made outstanding contributions to the community. Please provide detailed information to support your nomination.
Nominee's Full Name
*
First Name
Last Name
Nominee's Email Address
*
example@example.com
Nominee's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Nominee's Organization or Affiliation (if any)
Nominator's Full Name
*
First Name
Last Name
Nominator's Email Address
*
example@example.com
Relationship to Nominee
*
Reason for Nomination: Please describe the nominee's community service, achievements, and impact.
*
Please upload any supporting documents, letters of reference, or evidence of community service (optional)
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Eligibility Confirmation
*
I confirm that the nominee meets all eligibility criteria for this award.
Assessment of Nominee's Impact
*
Rows
Impact on Community
Leadership
Innovation
Sustainability of Efforts
Excellent
1
2
3
4
Good
5
6
7
8
Average
9
10
11
12
Needs Improvement
13
14
15
16
Additional Comments (optional)
Submit Nomination
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