2014 Washington State Jefferson Awards Nomination Form
Do you know people who have made a difference in your community? If so, nominate your community's "unsung" hero for a 2014 Washington State Jefferson Award!

The Jefferson Awards honor ordinary people who do extraordinary things for others. Initiated in 1972 to create a "Nobel Prize" for public service, awards are presented both nationally and locally. Join us to recognize Washington’s “unsung heroes” and to inspire volunteerism and action in our communities! Use the below form to nominate the people you know who make a difference: individuals who have made their community, the nation and the world a better place either through volunteer service or going above and beyond the call of duty at work.

For more information about the 2013 Washington State Jefferson Awards visit SeattleCityClub.org/JeffersonAwards.

DEADLINE FOR NOMINATION: Midnight, Friday, February 28, 2014

Please complete all sections of the nomination form. For questions, email JeffersonAwards@SeattleCityClub.org or call 206.682.7395.
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Judging Criteria
• Vision: Ability to imagine a better world and to articulate a desire for the common good

• Dedication: Commitment and follow through to realize goals

• Creativity and resourcefulness: Innovation in approach and problem solving

• Need: Urgency of work in the community

• Impact: Success in realizing vision
Nomination Form
First Name *
Last Name *
Title
Mr, Mrs, Dr, etc
Phone Number *
Email Address *
Street Address *
City *
State *
Zip Code *
Relationship to Nominee *
Nominee Information - Tell us about the person you are nominating
Last Name *
First Name *
Title
Mr, Mrs, Dr, etc
Phone Number *
Email Address *
Street Address *
City *
State *
Zip Code *
What are the areas of work for this person? *
Please check all that apply.
Required
This person's contribution has been primarily... *
How many years has the nominee given time and resources to help the community? *
Summary of nominee's accomplishments *
No more than approximately 100 words
Letter of Recommendation
As you write your nomination letter, explain how your nominee demonstrates:

• Vision: Ability to imagine a better world and to articulate a desire for the common good

• Dedication: Commitment and follow through to realize goals

• Creativity and resourcefulness: Innovation in approach and problem solving

• Need: Urgency of work in the community

• Impact: Success in realizing vision
Full letter of recommendation *
No more than approximately 750 words
Additional Materials
You may send no more than five (5) supplemental materials (articles, letters of recommendation, awards, etc.) We regret that we are unable to return enclosures.

Please note the nominee's name on each of the enclosures and send to:
JeffersonAwards@SeattleCityClub.org
or
Jefferson Awards
Seattle CityClub
1333 Fifth Ave, Suite 24
Seattle, WA 98101
or
206.467.7394 (FAX)

Hand delivered entries and/or supplemental materials must be received before 5 pm Friday, February 28, 2014.
I heard about the Jefferson Awards from: *
Please check all that apply
Required
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