Kirby Kids Nomination
Kirby Kids: Kids. Doing. Good.

In partnership with Great Lakes Credit Union, Little Lake County wants to recognize the extraordinary children and young adults ages 15 and younger who are serving as everyday heroes and role models in our community with the Kirby Kids program.

Do you know of an inspirational, courageous, and/or exceptional child who is making an impact in our community? Tell us about him or her! Complete this nomination form to submit the child for consideration in our Kirby Kids program. One child per month will receive a Youth Savings Account in their name with an opening deposit of $100 courtesy of Great Lakes Credit Union. The monthly winners will also be profiled in a featured article on LittleLakeCounty.com and their photo(s) and story will be shared on our Facebook page.

Please note that incomplete forms will not be considered. All decisions are made by Little Lake County Editorial Staff.

Child's Name *
Your answer
Child's Age *
Your answer
Child's Hometown *
Children must live in Lake County, IL
Your answer
Parent/Guardian Name: *
Your answer
Parent/Guardian Email: *
Your answer
Parent/Guardian Phone Number: *
Your answer
Your Name: *
Your answer
Your email: *
Your answer
Your phone number: *
Your answer
What is your relationship to the nominee? *
Your answer
Are the child's parents/guardians aware of this nomination? *
Required
In 500 words or less, please describe how the child has served or inspired his or her community. *
Please note that while the box looks small it can fit a lot of text.
Your answer
What obstacles has your Kirby Kid nominee faced?
Your answer
What special quality or characteristic have you observed in this child?
Your answer
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