Part 1 – Nominator’s Contact Information (* Required) Name of nominator* Nominating organization (if applicable) or individual Organization representative Nominator’s address*
E-mail*
Part 2 – Nominee’s Contact Information Name of nominee family* Home address* Business address*
Nominee E-mail*
May we notify nominee of your nomination?
Part 3 – Category Selection (Check one category) Community Leadership Family Foster or Adoptive Family Inspirational Family
Part 4 – Justification - Not to exceed 900 words Describe the nominated family, identify the reasons you believe they should be honored and briefly summarize the history of their service. Include names of the members of the immediate and/or extended family, the approximate ages of children if relevant, and other factors which are part of the family’s story. Note any known awards or citations for service or contributions.