Ivy Rose Award Nomination Form
Please complete and submit this form no later than November 29, 2021 at 5:00 p.m.  
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Email *
Date *
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Date *
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Name of Person Submitting This Form: *
Category *
Name of Organization / Individual / Non-Traditional Student *
If you are nominating an organization: Name of CEO / Director / President
Nominee's Address *
Nominee's Email *
Nominee's Phone Number *
Target Population of Organization or Individual
Planned Target Population of Non-Traditional Student
Year Organization Was Founded / Year Individual Began Serving the Brooklyn Community / Year Nominee Returned to School *
(A) Describe Organization’s / Individual's Activities  -- OR-- (B) Discuss Nominee's Degree or Professional Certification Program and Service Goals *
How has this organization / individual provided exemplary service to the Brooklyn community in the category referenced above? -- OR -- (B) Has this non-traditional student provided exemplary service to the Brooklyn community?  If so, please describe.  If not, please discuss the student's plan(s) to be of service to the Brooklyn community. *
How would this grant enable the organization / individual / non-traditional student to be an agent of change in Brooklyn (and beyond)? *
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