Nominate your Paxtang Hometown Hero!
Nominees must live or work in Paxtang Borough. Information collected on this form will be used for purposes of recognizing the nominees only. It will not be shared or used in any other fashion. Please provide YOUR email address so we can contact you with any questions about your nomination.
Your Name (First & Last)
Nominee's Name (First & Last)
Does the person?
Live in Paxtang Borough
Work in Paxtang Borough
Neither (not eligible for this program)
Nominee's Street Address or Place of Employment in the Borough
What category best describes your hero? (Select the primary category if more than one applies.)
Parent / Gaurdian / Other Family Member / Friend / Neighbor
First Responder / Medical Professional (Fire, Police, Doctor, Nurse, EMS, etc.)
Teacher / Coach / Pastor / Priest
Essential Worker (Delivery Worker, Retail Worker, Foodservice Worker etc.)
Please provide a short statement explaining why the nominee is YOUR Paxtang Hero:
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service