Nominee Full Name *

Nominee Email Address *

Nominee Phone Number *

Nominee Company Name *

Nominator Name *

Nominator Email Address *

Nominator Phone Number *

Nominee's Description of Service Project/Initiative *

Describe in detail the specific community service project or initiative the nominee is involved in. What is its purpose and scope?

Nominee's Role and Impact *

What is the nominee's specific role in this project? How has their direct involvement made a significant, positive impact on the community or a particular group of people?

Nominee's Time and Resources Committed *

Estimate the amount of time (e.g., hours per week/month) and any personal resources (e.g., financial contributions, supplies, specific skills) the nominee has dedicated to this endeavor.

Nominee's Longevity and Sustainability *

How long has the nominee been involved in this project? Is it an ongoing commitment, and what efforts have been made to ensure its sustainability?

Nominee's Inspiration and Leadership *

How has the nominee inspired others to get involved or demonstrate leadership within this community service effort?