Jeff Garrett Community Service Award Nomination Form
Deadline: December 22

This is your opportunity to acknowledge outstanding professionals and community leaders within your organization or with whom you conduct business. The Jeff Garrett Community Service Award is designed to recognize an individual who exemplifies outstanding service to Jefferson County by their actions and contributions to the community outside the work place. Nominees must be members of the Chamber to qualify.

Judging Criteria:
A panel of judges will independently score each of the nominations based on their written application.

Qualifications:
- Individual has made major contributions to the quality of life in Jefferson County
- Individual is a resident of Jefferson County in good standing
- Individual has distinguished himself/herself through outstanding service to Jefferson County in one or more of the following areas: community service projects, youth work, civic club service, church activities, civic improvement projects, philanthropy, or economic development.
- Individual has a positive public image and strives toward professional accomplishment
- Individual has served the community outside the workplace
- Individual is not a previous Jeff Garrett Community Service Award recipient
- Individual is not a current elected political official
- Individual has exemplary public image favorable to chamber goals
- Individual has given extra effort to business issues

Please provide the following information about the person you are nominating:
Name of Nominee
Your answer
Home Address
Your answer
Work Address
Your answer
Email & Phone Number
Your answer
Please provide the following information about yourself:
Name of Sponsor
Your answer
Home Address
Your answer
Email & Phone Number
Your answer
Relationship to nominee
Your answer
Please answer the following questions about the person you are nominating.
Please list and describe the significant contributions that the nominee has made to their organization(s) including involvement, offices held, and period of time in each.
Your answer
Please list examples of the nominee’s professional contributions.
Your answer
Please list specific examples where the nominee has demonstrated leadership roles in community service and how his/her contributions have benefited the community.
Your answer
Please provide a brief background of nominee’s work experience in Jefferson County.
Your answer
Please provide a brief background of their family history (optional).
Your answer
Please list any additional information you would like the selection committee to consider.
Your answer
Please type your name and the date below, as a signature that the above information is accurate to the best of your knowledge.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Madison Chamber & Industrial Development. Report Abuse - Terms of Service