Nominee Information

Children’s Board Unsung Hero Award

Recognizing individuals who have made an extraordinary contribution in our community and improved the lives of children

Deadline for submission is Friday March 17th

Days

Hours

Minutes

Seconds

Nominee’s Name

Address

City

State

Zip

Employer (if applicable):

Position

Business Address

City

State

Zip

Phone

Work

Fax

E-mail Address

Nominator’s Name

Business Name/Organization (as applicable)

Address

City

State

Zip

Phone

Work

Fax

Nominator E-mail Address

Relationship to Nominee (friend, co-worker, etc.)

Other, please explain

1. How long have you known the nominee?

2. Tell us why are you nominating this person?

3. Name the organizations with which the nominee has worked/volunteered

4. How many years has the nominee been working with children/youth?

5.Explain the specific nature of the contribution/work your nominee does

6. Explain any lasting impact due to the nominee's contributions/work

7. If applicable, Has this nominee demonstrated any leadership? Developed a program? Etc.

8. Is this nominee compensated for their contributions/work?

9. Does this nominee work full or part time? If yes, where and how many hours worked?

10. Summarize why this nominee deserves the Hon Kachina Volunteer Award?

In order to qualify, a nominee must have three (3) references who may be contacted to verify the scope and extent of the nominee’s activities. References should be people familiar with the nominee’s community service activity and should not include the nominee or any person related to the nominee.

1. Name

1. Phone

1. E-mail

1. Relationship

1. References and supporting documents

2. Name

2. Phone

2. E-mail

2. Relationship

2. References and supporting documents

3. Name

3. Phone

3. E-mail

3. Relationship

3. References and supporting documents