Community Inspiration Award Nomination Form

Submitter's Information

Award submitted by *

Your First Name *

Your Last Name *

Your Email Address *

Your Business Phone *

Nominated Advisor’s Information

Enter the following information about the nominee (if different than submitter).

Nominee’s First Name *

Nominee’s Last Name *

Nominee’s Email Address *

Nominee’s Business Phone *

Is the nominated advisor affiliated with the charitable organization in any way? *

Yes

Examples: Nominee is on the board of directors; Nominee is an officer of the organization; Nominee is paid by the organization as a client or for other services.

If you answered Yes to the above, please describe:

Charitable Organization’s Information

Organization Name *

Is the organization qualified as a 501(c)(3) non-profit? *

Can or does the organization contribute to a political candidate or Political Action Committee? *

Describe specific contributions/results the nominee has provided to this organization: *

Highlight contributions through volunteer, professional, or philanthropic efforts. How do they go above and beyond to create a positive impact in the community?

How did the nominee get involved with the organization? *

Why is the work of the organization meaningful and who does it benefit? *

Are any links you want to share? (Articles, websites, social media?) *

Does the nominee direct money for the charitable organization? *

Yes

NOTE: The nominated advisor must not have sole responsibility for controlling money donated to the organization. He or she can direct such money if the decisions are made by the organization's board.