CFE 011000 - Laserfiche WebLink

Browse Search

Ru Category (circle one ONLY) : Adult Youth ( DOB : 3 ' ) Group (# of volunteers ) Education 11 Nominee Name : If Group, Contact Name. Daytime Phone: ( ) Other: ( ) Street Address : City/State/Zip• Number of years nominee has volunteered : Hours per month : Employment Status (circle one) : Full -time Part-time : 'Retired School Other Has nominee previously been nominated (circle one) ? Yes Wo :. $ 1 ,000 Winner? ;.' $ 250 Finalist ? If Yes , what year Volunteer Organization : ( Name of organization for which nominee volunteers) Organization : - Phone : ( ) Street Address : City/State/Zip: , Agency Director : 501 ( C) ( 3 ) Status (circle one) _ Yes No Services provided : Verification : (Two references who may be contacted to verify the scope and extent of the nominee 's activities . References cannot include the nominee or relatives of the nominee .) Name : Organization : Phone : ( ) Street Address ICity/State/Zip : Name . Organization : Phone : ( ) Street Address : City/State/Zip: . Nominator : Name . Phone : ( ) Street Address : City/State/Zip : Signature : Date: Organization (if not affiliated with any organization , state relationship to nominee) : Print or type answem to the following't using separate sheet (s) of paper: Activity: Describe nominee 's volunteer service (s) . . . - Achievement: Did nominee accomplish desired results ? Explain. Need : Describe need for nominee's services) Impact: Describe impact or difference nominee 's service Action : Was nominee active , founder, figurehead ? Explain . made to community. Hovv ' many ;people were affected ? Initiative : Did nominee start new program , use new Challenges: Did nominee overcome challenges (physical methods to solve problems , initiate activities , promote or mental handicaps , limited resources , public perception) ? collaboration with other organizations ? Explain . Other: Why do you believe your nominee deserves the Golden Rule Award ?