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2. Nominee Information
4. Name*
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
15. Selection Criteria
    Recipients must possess some of the following attributes and ideals: Dedicates a significant amount of volunteer time to projects/programs; makes a significant contribution to a project, program, or ongoing activity that enhances the community; demonstrates a passion and commitment to creating a healthy and vibrant community; provides leadership and/or opportunities for collaboration; serves as a role model; exemplifies the spirit of a good citizen or organization; serves a vital role that is not otherwise fulfilled in the community; inspires others to engage in community service.
17. Please provide specific examples of the nominee's contributions and/or leadership that demonstrate how the award nominee fulfills some or all of the criteria listed above.*
19. Nominator Information
21. Name*
22. Phone Number*
24. Email Address*
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

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