Youth Nomination Form

Full Name *

Mailing Address *

City, State, Zip Code *

Phone Number *

Email Address *

Relationship to the nominee *

Nominee’s full name *

Mailing Address *

City, State, Zip Code *

Phone Number(s) *
Phone Number 1
Phone Number 2

Email Address *

School Name *

Age *
Select Nominee's Age 12 years 13 years 14 years 15 years 16 years 17 years 18 years

Gender *
Male
Female

Nomination category (check all that apply) *
Heroic resilience: this courageous young person has overcome or is in the midst of overcoming challenges in his/her life.
Community service: this young person voluntary contributes to and serves his/her community family church, or school, giving of him/herself to support others.
Strength of character: this young person is admirable for his/her efforts to remain true to his/her character by being honest, respectful, and/or standing up to peer pressure.

Nominee’s Story *
Write the story of the young person who you are nominating for the Youth of the Month Award.
In the narrative please include the following information: How you know the nominee; which nomination categories you selected and how nominee demonstrates those traits; and specific examples of why you are nominating the youth. Narrative can not exceed 1,500 characters.
Nominee’s Story: Write the story of the young person who you are nominating for the Youth of the Month Award. In the narrative please include the following information: How you know the nominee; which nomination categories you selected and how nominee demonstrates those traits; and specific examples of why you are nominating the youth. Narrative can not exceed 1,500 characters.

Activities and Accomplishments *
Please list any extra curricular activities or accomplishments of young person who you are nominating for the Youth of the Month Award. Activities and Accomplishments can not exceed 500 characters.
Activities and Accomplishments: Please list any extra curricular activities or accomplishments of young person who you are nominating for the Youth of the Month Award. Activities and Accomplishments can not exceed 500 characters.

Other supporting information (Optional)
Include up-to three supporting documents that demonstrate why nominee should be selected as a recipient of the Youth of the Month Award. Attachment examples include: letter of recommendation, resume of nominee, service activities, letter from nominee or any other relevant information.
First supporting information (Optional): Include a supporting document that demonstrate why nominee should be selected as a recipient of the Youth of the Month Award. Attachment examples include: letter of recommendation, resume of nominee, service activities, letter from nominee or any other relevant information.
Second supporting information (Optional): Include a supporting document that demonstrate why nominee should be selected as a recipient of the Youth of the Month Award. Attachment examples include: letter of recommendation, resume of nominee, service activities, letter from nominee or any other relevant information.
Third supporting information (Optional): Include a supporting document that demonstrate why nominee should be selected as a recipient of the Youth of the Month Award. Attachment examples include: letter of recommendation, resume of nominee, service activities, letter from nominee or any other relevant information.