2017 Addink Award Nomination Form

THE AWARD:

The Addink Community Community Service Award is presented annually to one individual, or family, who has made a positive impact on the community through volunteerism. The deadline to submit a nomination is Sept. 18, 2016.

This year's honoree will be presented the award during Promise Community Health Center's annual "An Evening of Promise" celebration on Thursday, Nov. 2, 2016, at Terrace View Event Center in Sioux Center. The honoree will be notified prior to the event and recognized publicly.


AWARD CRITERIA:

The award recognizes and honors an exceptional individual or family that makes volunteerism and community service a way of life. The award recipient exemplifies the best in volunteering, a sense of caring and responsibility for others, for the betterment of the local community and beyond.

Specifically, the winner will be someone who:
 Gives freely and unselfishly of their time to community activities;
 Inspires others to serve and acts as a role model;
 Has a positive impact upon the direction and success of community projects, programs or individuals;
 Improves the lives of others.


For more information about the award, visit this link to see the full criteria: goo.gl/xffT2C.


Please fill out the following nomination form completely with complete sentences. We may use some of the information that you provide for a feature story on the honoree.

What is your name?
Your answer
What is your telephone number?
(Please include in case we have follow-up questions.)
Your answer
What is your email address?
(Please include in case we have follow-up questions.)
Your answer
Who are you nominating?
Your answer
List the volunteer and community service roles that individual fulfills.
(Please double-check spelling of names of organizations, committees, programs, projects, etc.)
Your answer
Describe the time, effort and initiative that individual puts into his or her community service roles.
(Please be as specific as possible.)
Your answer
How has the individual's efforts made an overall positive impact? (For example, how has he or she impacted the direction and success of the community organizations, programs or projects that he or she has been involved in? How has he or she improved the lives of others? How has he or she inspired others to serve or has acted as a role model?)
(Please use complete sentences.)
Your answer
Overall, why is this person worthy of the Addink Community Service Award? Why do you nominate him or her?
(Please sum up your reflections in two to three complete sentences.)
Your answer
If the individual is selected, how do we contact him or her?
(Please provide a telephone number and/or email address.)
Your answer
Submit
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