T. Roy Adams Humanitarian of the Year Award Nomination Form

Nominee Information

* First Name

* Last Name

* Occupation

* Address

* City/Town

* Postal Code

* Phone xxx-xxx-xxxxx

Ext.

* Email

Sponsorship

Nominees will remain eligible for three years. Applications made for this year, the three runners up will automatically be forwarded to the next 2 years.

This Nominee is being Sponsored By:

• An organization
• Two individuals (co-sponsors, not related to the nominee)

Nomination Details

Provide a detailed description (approximately 700-1000 words, two typed pages) that highlights the nominee's lifetime commitment to community service and volunteerism.

Provide an explanation as to why you feel the nominee deserves to be recognized with this award?

Supporting Documentation

You may attach additional letters of support to be included in your application.

Verify your Submission

Verify your submission by typing the 6-digits you see in the box:

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