2019 United Way 'Community Impact Award' Nomination Form
The United Way of Pickaway County seeks to recognize one outstanding community member who has gone above and beyond to change lives for the better over the past year.

There are 3 phases to the nomination process. Starting June 24th through July 19th, county residents are encouraged to nominate a deserving individual for consideration for the award.

From there, nominees will be narrowed down to 10 candidates in round two voting to take place July 26th through August 9th. The Top 5 community vote earners will then be recognized at the United Way of Pickaway County's 2019 "United We Serve Gala" on Saturday, November 2nd where the winner will be announced. The 2019 honoree will then be recognized over the course of the coming year and have four student scholarships named after them awarded to high school seniors in May 2020.

To begin the nomination process, fill out the form below to nominate a worthy individual that has changed Pickaway County for the better.

Eligible applicants must work live, volunteer, or work in Pickaway County in a United Way of Pickaway County Impact Field of Education - Safety Net - Income Support - or Health (This is not limited to one of the partner agencies we support).

Person nominating (First/Last) *
Your answer
Person nominating's email address *
Your answer
Person nominating's phone number *
Your answer
2019 United Way of Pickaway County Community Impact Award Nominee (First and Last) *
Your answer
Nominee's Impact Area *
Nominee's place of impact (work or volunteer) *
Your answer
What leads you to nominate this individual for the 2019 United Way Community Impact Award? *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service