Community Volunteer of the Month
Nomination Form
Please fill out this form completely to properly submit your nomination.
Agency Information:
Agency Name:
Address:
Phone:
Website:
Contact Person:
Contact Person's Title:
Contact Person's Email:
I / we proudly nominate:
Volunteer Name:
Volunteer Age:
(select one)
8-17
18-24
25-34
35-50
51-65
65+
Volunteer Ethnicity:
(select one)
African American / Black
Asian / Asian-American
Caucasian / White
Hispanic / Latino
Native American / Alaskan Native
Pacific Islander
Other
(no response)
Volunteer Position:
Volunteer's Address:
Time Volunteered with Agency:
Reason for Nomination:
(Please be specific. Creativity counts!)
Interesting Facts and Statistics:
(This may include details such as number of clients served, number of crafts made, number of hours donated. Be creative!)
Additional Information:
In order to protect our site from spam,
please type the words exactly as they are displayed below and hit the "Submit" button to complete your nomination.
