Recognition Award Nomination Form

Name of Nominee:
E-mail Address:
Organization (if applicable):
Address: City: Zip:
Daytime Phone: Fax:

Name of Nominator:
E-mail Address:
Organization (if applicable):
Address: City: Zip:
Daytime Phone: Fax:

Consider the categories below when completing your nomination. Narratives should include specific examples when applicable. Please keep the length to approximately one page.

Asset building - How has nominee built assets in youth? Please click here for a listing and description of the 40 Developmental Assets.

Accomplishments/Impact – What has the nominee achieved? Has nominee engaged youth? How has nominee improved the lives of youth?

Mentor – How has nominee served as a role model for youth (and adults)?

Service to others – How has nominee contributed to the positive development of youth through giving of time, talent and treasure?

Leadership – Has nominee started a new program, taken initiative, or encouraged others to join in practicing positive youth development?

Commitment – How much time has nominee spent building assets in youth? For how many years has nominee been promoting positive development with youth?