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Section 1 of 2
Nominate someone that lives, works or volunteers in the following geographic areas:
Leland, Belville, Winnabow, Town Creek, Northwest, Navassa
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Nominee's geographic location:
Nominee's geographic location:
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1.
Leland
2.
Belville
3.
Winnabow
4.
Town Creek
5.
Northwest
6.
Navassa
7.
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Nominee First & Last Name:
Nominee First & Last Name:
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Nominee Age (must be under 40 years of age):
Nominee Age (must be under 40 years of age):
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Nominee Place of Employment:
Nominee Place of Employment:
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Nominee Job Title:
Nominee Job Title:
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Nominee LinkedIn Profile URL:
Nominee LinkedIn Profile URL:
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Nominees Email Address:
Nominees Email Address:
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Nominees Phone #:
Nominees Phone #:
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Please describe the nominee's career path and/or current position:
Please describe the nominee's career path and/or current position:
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How has the nominee made an impact on the community?
How has the nominee made an impact on the community?
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How has the nominee exhibited any or all of the following qualities: drive, motivation, forward-thinking attitude, innovation, community involvement, and/or leadership?
How has the nominee exhibited any or all of the following qualities: drive, motivation, forward-thinking attitude, innovation, community involvement, and/or leadership?
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Does the nominee currently volunteer? If so, where and how long has he/she volunteered?
Does the nominee currently volunteer? If so, where and how long has he/she volunteered?
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Is there anything else about the nominee that you would like to tell us?
Is there anything else about the nominee that you would like to tell us?
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Section 2 of 2
If you are not the nominee, please complete the following:
First & Last Name:
First & Last Name:
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Contact Phone Number:
Contact Phone Number:
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Email Address:
Email Address:
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Relationship to Nominee:
Relationship to Nominee:
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