Community Volunteer of the Month
Nomination Form
Nominating Agency Name:
Agency Contact Person:
Agency Contact Person's Title:
Agency Contact Person's Email:
Agency Address:
Agency Phone:
Agency Website:
Volunteer Name:
Volunteer Position:
Volunteer Address:
Time Volunteered with Agency:
Interesting Stats:
(this may include facts such as number of clients served, number of crafts made, number of hours put in. Be creative!)
Reason for Nomination:
(Please be specific. Creativity counts!)
Additional Information: