Nominee’s Information

First Name

Last Name

Address

City, State, Zip

Daytime Phone

Fax

Email

Category
PLEASE SELECT Senior Corps AmeriCorps Learn and Serve Corporate/Foundation Nonprofit Organization or Individual

Service Dates

Nominator’s Information

First Name

Last Name

Address

City, State, Zip

Daytime Phone

Fax

Email

In 300 words or less, please describe the significant and lasting contributions the nominee has made to their community. Nominees must exemplify the spirit of national service, demonstrate exceptional service or leadership, and serve as role models for others in their community. Your narrative should address one or more of the qualities listed in the call for nominations (Please look under the Documents tab) and if they are a Senior Corps or AmeriCorps member include the name of the local program in which the individual served.

Privacy Policy: You are advised that a nominee's name, as well as all submission material, may be used for news or publicity programs connected with ServeWyoming. Contact information, however, will not be shared with anyone outside of ServeWyoming, and only with individuals within the organization who have an official need to know the information. Finally, if a nominee or nominator does not want his or her name and / or narrative information used for purposes of news, publicity, or publications, please indicate this within your submission.

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