2020 WBYA Youth Recognition Award Nomination Form
Eligibility and Nomination Instructions

1. Nominees should reside within the boundaries of the West Bloomfield School District or be a West Bloomfield School District student, however, consideration will also be given to students residing outside of the district if they serve the West Bloomfield community.

2. All school age youth are eligible.

3. A youth may receive only one award as an elementary student, one as a middle school student and one as a high school student. A recognition letter will be sent to all nominated students who have previously received an award and are therefore ineligible for award this year due to the aforementioned rule.

4. Nominations must be submitted through this Google form or by sending an electronic copy to emily@wbyouthassistance.org and received by Friday, March 6th, 2020.

5. A youth nominated for an award due to volunteer service hours may not be nominated for services rendered to acquire school credits or court required community service unless the student personally chooses to continue beyond the required hours and shows dedication and commitment above and beyond what is required of them.

6. Examples of reasons for nomination include:
• Volunteer Service - to an individual, organization or the community.
Some examples of Volunteer Service are:
• Hospital or nursing home volunteers
• Beautification activities exceeding 15 hours of personal time
• Tutoring other students
• Service to vulnerable populations
• Volunteer service with local non-profit organizations
• Personal acts of heroism and/or unexpected kindness
• Self-improvement through personal and/or academic achievement

7. Individuals may nominate an unlimited number of students, however, each student that may be recognized needs a separate form filled out. Additional forms may be copied or obtained at the West Bloomfield Youth Assistance office.

8. During the ceremony, the nominator is usually the one that reads their submitted remarks and presents the youth with their award. If you are unable to do so for any reason, please try to find a stand in that also knows the student well. This adds a personal touch that helps the student feel recognized by someone that truly knows them. All presenters must be committed by March 31st.


Completed forms must be received no later than Friday, March 6th, 2020.
Nominations may be submitted through this Google form or emailed to emily@wbyouthassistance.org.
Email address *
Date *
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Nominee's Full Name (PLEASE double check the spelling before submitting the nomination as this is what we go off of to format the certificates the student will receive) *
Your answer
Nominee's Age *
Your answer
Nominee's Full Address *
Your answer
Nominee's School *
Your answer
Nominee's Grade *
Your answer
Parent/Guardian's Name(s) *
Your answer
Parent/Guardian's Address (if different than the student)
Your answer
Parent/Guardian's Email Address *
Your answer
Parent/Guardian's Phone Number *
Your answer
Nominator's Full Name *
Your answer
Nominator's Full Address *
Your answer
Nominator's Organization *
Your answer
Nominator's Email Address *
Your answer
Nominator's Phone number *
Your answer
In 150 words or less, please describe the nominee's accomplishment and/or special achievement. Please take care to review your submitted remarks as this will be what is read during the ceremony if your nominee is recognized. *
Your answer
Do you have any additional notes or comments on your nominee for the Youth Recognition Committee to consider? *
Your answer
If your nominee is chosen to receive an award, would you be available to read your remarks and present the nominee with their certificates during the ceremony on Wednesday, April 22, 2020 at 6:30pm? All presenters must be committed by March 31st. *
If you are unable or unwilling to read the remarks, who could we ask to stand in for you?
Your answer
Potential Stand In Email Address and Phone Number
Your answer
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