Nomination Form- IMPACT St. Louis Awards
Please answer as many questions as are relevant. Not all will apply to each award. Thank you for your time in nominating an individual or organization.
Email address *
IMPACT Category
*Notice categories are specified as Personal or Organization
Which IMPACT category are you nominating a person or organization?
Name of Individual or Organization you are nominating *
Your answer
*If Organization, please complete the following for us to contact
If Individual, please skip to next section
Name of the Key Contact(s)
Your answer
Title or Role
Your answer
Company Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Email address for key contact
Your answer
Phone number
Your answer
Name of Assistant, if applicable
Your answer
About the Nominee
To get the best understanding of this person or organization, please provide as much info as possible. Some of the categories may not be completely relevant, but the more information the nominator can provide will help the judging panel have better insight into the nominee’s overall contributions.
Provide an overview as to how this person or organization has impacted the St. Louis area. How is this person/organization of value to our community?
Your answer
How have the individual/organization made a lasting impact on the St. Louis region? What was innovative about their contribution?
Your answer
What type of collaboration was involved?
Your answer
Gateway to Dreams strongly encourages the creation of an on-going ripple of paying it forward. How has this contributor created a paying it forward situation?
Your answer
How can this contribution be duplicated? Please explain how others might work to duplicate this effort.
Your answer
What is the long-term impact to the community?
Your answer
How has this individual, or people in the organization, gone above and beyond?
Your answer
How can this be translated into creating a legacy?
Your answer
Other relevant information about this nominee
Your answer
Your Information
Tell us about YOU! And THANK YOU for making an IMPACT by taking the time to nominate an individual or organization.
Nominated by: (Your Name) *
Your answer
Relationship, if any, to the nominee
Your answer
Your preferred method of contact for additional information
What is your email, phone, or cell phone information for the above preferred method of contact?
Your answer
Please Review This Form Before Submitting. All Forms Must Be Completed By Midnight on Friday, March, 22nd, 2019
Should you have questions, please contact Karen Hoffman at Karen.Hoffman@GatewayToDreams.org.

Gateway to Dreams (G2D) is a Not-for-Profit 501(c)(3) organization.

A copy of your responses will be emailed to the address you provided.
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