Recognition Award Nomination Form

Please fill in all the fields as completely as possible and fax to 228-7712 or mail to the Great Lakes Center for Youth Development at 307 South Front Street, Marquette, MI 49855. The winner will be personally notified.

Date: _________________________

1. Name of Nominee:_________________________________________________

Organization (if applicable):____________________________________

Address:_________________________ City:____________ Zip:_________

Daytime Phone:________________________ Fax:______________________

2. Name of Nominator:_______________________________________________

Organization (if applicable):____________________________________

Address:_________________________ City:____________ Zip:_________

Daytime Phone:________________________ Fax:______________________

3. Please indicate why the person, group or organization you are
nominating qualifies for the "Put the Youth Into Youth" Recognition
Award. Give examples of why you believe they "Put the You Into Youth"
and promote positive youth development.

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