2018 Take A Stand for the Revolution Award Nomination Form
This form is to submit names for individuals for the 2018 Take a Stand for the Revolution Award. Nominations must be made by Thursday, February 15th, 2018. You may make as many nominations as you would like. You may nominate yourself.

Qualifications for this award include anyone in the Twin Port's region exemplifying education equity, racial equity, community service, peace, and/or justice in their life and work.

The award winner will receive $500 total, $250 for them and $250 for them to contribute to an organization of their choice.

Nominees will be notified by phone and/or email communication by Monday, February 19th 2018. Awards will be presented at the 2018 NAACP Freedom Fund Dinner February 23rd at Clyde Ironworks located at 2920 W Michigan St, Duluth, MN 55806.

If you have questions regarding this award or this form, contact Elena Bantle at 218-310-6519 or elena.bantle@gmail.com

Your Name *
Your answer
Your Phone Number *
Your answer
Your Email *
Your answer
Nominee's Name *
Your answer
Nominee's Phone Number *
Your answer
Nominee's Email *
Your answer
Nominee's URL (LinkedIn, Facebook, Instagram, or Personal Website)
Your answer
In three(3) sentences or less, tell us why the nominee deserves this award. *
Your answer
List achievements, accomplishments, and/or responsibilities of the nominee. *
Your answer
List up to 3 organizations the nominee is affiliated with. *
Your answer
Is the nominee available to attend the Freedom Fund Dinner? The dinner is February 23rd, 6PM (doors open at 5PM for art show) at Clyde Iron.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms