Niagara Library Name
Your Name *
Your Phone Number *
Your Email Address *
Affiliation
FULL NAME OF NOMINEE: *
Criteria for nomination: Nominee(s) must be of Hispanic/Latino descent, must be deceased, and must have made a significant contribution to theHispanic/Latino Community and the City of Buffalo(please include nominee information form(s) and supportive documentation for each nominee).
Date of Birth *
MM
/
DD
/
YYYY
Date of Death *
MM
/
DD
/
YYYY
Hispanic Country of Origin/Descent: *
Detailed Description of Contributions to the Community: *
List Supportive Documentation Attached: (May be resume, newspaper clips, pictures, testimonials, etc.)
Upload digital supporting documents (listed above) here:
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