Dancing with the W-2 Stars Dancer Nomination
Please fill out this survey entirely for the individual you are nominating.

Keep in mind when nominating a star:

We are looking for local "Stars" to participate in our fundraiser for Valley Residential Services. A Star is someone who has shown through their actions and attitude a love for helping others and a passion for making our community a better place.

This event is a FUNDraiser. The Star will be expected to participate in fundraising efforts.

The event is held in October, and there will be several practices in the weeks leading up to the event. These practices can be scheduled to fit into the dancers work and family schedule.

Thank you! We look forward to receiving and viewing your nominations!

Nominator Information
Name
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Address
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City
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State
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Zip/Postal Code
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Email Address
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Phone Number
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Nominee Information
Name
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Address
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City
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State
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ZIP/Postal Code
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Email
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Phone
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Employer and Job Title of Nominee
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Please describe the nominee's community involvement. Include any clubs and organizations the nominee is involved in.
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Why would this nominee be a good fit for a Valley Residential Services fundraiser?
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