Forget-Me-Not Volunteer of the Year Nomination Form

(Please print out form, fill it out, then mail to address below)

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Name of Nominee (group/person):
Street Address (group/person):		State:
City:		ZIP:
Phone #:	E-mail Address (optional):
	Website Address (optional):
Occupation (Past or Present):

Community/Intergenerational Service

1. In what ways has this person or group improved the lives of homebound seniors or seniors in nursing homes?

2. List any additional volunteer, charity, or community work by either the person or group:

3. List any previous awards won by the nominee/s:

Special Talents, Interests, and Hobbies
1. Does the nominee play a musical instrument or sing?
2. Does the nominee use the Internet to promote or advance their charitable work?

I am nominating this person or group as Forget-Me-Not Volunteer/s of the Year because:

Things you need to know:
1. Must provide a nonreturnable photograph of the nominee/s.
2. Please provide the contact information of a local newspaper including Feature writer's name, phone, and fax number.
3. Send nominations to:	Forget-Me-Not Committee
	339 East J. Street, Chula Vista, CA 91910
4. Deadline for nominations: August 10, 2009

Nominator Contact Information
Name:		Occupational Title:
Street Address:		State:
City:		ZIP:
E-mail Address (required):
Work Phone #:		Home Phone #:
Name and phone number of personal reference(s):

Signature of Nominator:
Date:

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