2019 OUTSTANDING OLDER AMERICAN AWARDS NOMINATION FORM
SELECTION OF MAUI COUNTY’S OUTSTANDING OLDER AMERICANS YEAR 2019

PURPOSE
* To honor older adults who contributed significantly to improving community life
* To encourage participation in community activities
* To honor significant contributions provided by volunteer caregivers to the community
* To recognize the exploration of new interests, endeavors, and accomplishments.

ELIGIBILITY
* Nominees are desired from all segments of the community.
* While they may be members of senior clubs, churches or other organizations, it is not mandatory that the nominee belong to an organization.
* The nominee must be age 65 years or older and a resident of Maui, Molokai, or Lanai. Points will be awarded for services provided in the community after attaining age 60.
* The following are not eligible: Past award winners (those who have been selected as the Outstanding Male or Female Older American of Maui County), Council on Aging Members, and Maui County Office on Aging staff.
*Nomination papers may be submitted by the candidate, another individual or an organization.
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Nomination DEADLINE: March 29, 2019 by 4:30 p.m.
Call 270-7755 to confirm receipt of forms.

Awards Ceremony and Luncheon
Thursday, May 16, 2019
11:00 am to 1:00 pm
Kihei Community Center

Email address *
Nominee’s Information
Please enter information about the person you wish to nominate.
Nominee’s Last Name *
Your answer
Nominee’s First Name *
Your answer
Middle Initial
Your answer
Street/Mailing Address *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Second Phone Number (if applicable)
Your answer
Nominee's Email Address
Your answer
Nominator’s Information
Nominator’s Last Name *
Your answer
Nominator’s First Name *
Your answer
Middle Initial
Your answer
Street/Mailing Address *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Second Phone Number (if applicable)
Your answer
Email Address
Your answer
Optional:
Nominator's Club or Organization Affiliation
Your answer
Nominee’s Club or Organization Affiliation
Your answer
Nominee's Age *
Your answer
Birth Date (Must be 65 years or older)
Your answer
VOLUNTEER SERVICE, LEADERSHIP AND/OR CAREGIVING ACTIVITIES AFTER AGE 60
List services the nominee provided to the community, friends, neighbors, and/or family members and the capacity in which nominee served after age 60, and the approximate hours per month. *For judging purposes, please do NOT state nominee’s name.
Service or Organization {List All}
Your answer
Position in which served (example: president, founder, officer, member, volunteer, or volunteer supervisor) {List All}
Your answer
Estimated Years of Service {List All}
Your answer
Estimated Hours Volunteered Monthly {List All}
Your answer
HOW MANY PEOPLE WERE HELPED BY VOLUNTEER’S CARE, SERVICE OR ACTIVITIES? HOW WERE THEY HELPED? WHO BENEFITED? Provide examples.*For judging purposes, please do NOT state nominee’s name.
Your answer
PERSONAL ACHIEVEMENTS AFTER AGE 60. In the space below, provide brief information on the nominee’s personal achievements, new activities or new occupations after age 60. *For judging purposes, please do NOT state nominee’s name.
Your answer
Explain why you feel this nominee deserves to be the Outstanding Older American 2019. In the space below, provide your story, explanation, or justification in narrative form. *For judging purposes, please do NOT state nominee’s name. Replace nominee’s name with “Nominee”
Your answer
OPTIONAL BACKGROUND INFORMATION
-- WILL NOT BE USED FOR JUDGING PURPOSES --
Nominee’s Name:
Your answer
Birthplace
Your answer
Occupation(s) prior to age 60:
Your answer
Special Interests or Hobbies:
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Family History (spouse, children, etc.):
Your answer
Explain why this person should be selected as the 2019 Outstanding Older American in Maui County
Your answer
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