2018 JuneteenthTrailblazer Award Nomination Form
EMERGING ACTIVIST: This individual is someone who is emerging into activism in their schools as well as in the local community. They are beginning a life that is strongly involved in civil rights and positive change.

OUTSTANDING LEADER: This individual is an outstanding individual who has developed a career dedicated to advocating for marginalized and oppressed groups. They have taken up their own leadership in benefiting this community.

TRANSFORMATIVE ORGANIZATION: This organization has contributed to civil rights over a significant number of years through activism and advocacy. They have supported and changed the landscapes of civil rights in the Iowa City area. They have tirelessly served their community while inspiring other around them to do the same.

The application is due May 8, 2018.
Email address *
Nominee Name *
Your answer
Nominee Title (if applicable)
Your answer
Reason for nominating this individual (250 words or less) *
Your answer
Person Nominating *
Your answer
Your Contact Information
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy