2012 CITY OF ELMHURST CHARACTER COUNTS SERVICE AWARDS NOMINATION FORM FOR YOUTH & ADULTS
Eligibility Requirements

1. Volunteer must be an Elmhurst resident (Elmhurst address), or live within District 205 boundaries, or have performed services that benefited the Elmhurst Community.
2. The award is focused on individual and group achievement.
3. The service must be voluntary and unpaid.

Note:  Family and self nominations will not be accepted.

Due Date:  Nominations must be submitted, by Friday, February 10, 2012.
                    (Nominations received after this date will not be considered.)
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Volunteer’s Age Category: *
Volunteer’s Name: *
E-mail *
Address: *
Home Phone: *
Other Phone:
Parent/s/Guardian Name *
Age of Volunteer *
Address, if different than above:
Hours of Service Performed: *
Nominator Information
Name:   *
(Not a family member or self.)
Organization: *
Address *
Phone: *
Other Phone
Email Address: *
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