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YICU Nomination Form
YICU Service Award recognizes young adults, ages 12 through 22, who have demonstrated commitment to community service and leadership. Thank you for nominating a candidate for YICU Service Award. If you are choosing to self-nominate, please complete the following application form -

You can edit/update your responses as many times as you prefer, after your initial submission. You will receive "Edit your response" link directly after submitting, in the confirmation page. You can bookmark that link for later access. Alternatively, you can edit the form through the confirmation email that you will receive after submitting your form.

For additional information about YICU, please access the following link -

Thank you!
YICU Service Award Steering Committee

Email address *
Name *
Your answer
Nominee *
Please share the name of the young person you are nominating for YICU service award.
Your answer
Nominee's Email *
Please share the email address of the young person you are nominating for YICU service award. YICU steering committee will reach out to this individual, via email, to gather additional information.
Your answer
Nominee's Phone Number
This information would only be used if the steering committee is unable to reach the nominee via email.
Your answer
Have you informed this individual about this nomination? Please note that the nominee needs to complete an application to be considered for this recognition. *
Please share any additional information that may assist the YICU selection committee.
Your answer
A copy of your responses will be emailed to the address you provided.
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