Dr. MLK Recognition Award - Nomination Form
|
|
NOTE: A photograph of the nominee (suitable for publishing in the Commemorative Journal, should the nominee be selected) and two (2) letters of recommendation are required. These items may be sent via
e-Mail: ncmlk@verizon.net or by mail to:
Dr. MLK B'day Celebration Committee of Nassau County, Inc.
240 Old Country Road (Room 601), Mineola NY 11501.
Nominations for the 2010 Awards must be received by October 31, 2009.
|
| Nominee 1st Name: |
|
| Nominee Surname: |
|
| Middle Initial: |
|
| Title: |
|
| Organization: |
|
| Phone: |
|
| Fax: |
|
| e-Mail: |
|
| Choose a field in which Nominee has "built bridges" |
|
| |
Civil Rights |
| |
Education |
| |
Employment or Economic Development |
| |
Humanitarianism |
| Describe, in general, why Nominee deserves this award (30 words or less) |
|
| What need is addressed by Nominee's work, activity or achievement?: |
|
| Why is Nominee's work, activity or achievement important?: |
|
| Who is serviced by Nominee's work, activity or achievement?: |
|
| How does Nominee impact the local or greater community?: |
|
| Is Nominee's work, activity or achievement paid or voluntary?: |
|
| If paid, what aspects of Nominee's work, activity or achievement are beyond the "call of duty"?: |
|
How does Nominee's work, activity or achievement exemplify the goals of
Dr. Martin Luther. King, Jr?: |
|
| Nominator's Full Name: |
|
| Nominator's Title: |
|
| Organization: |
|
| Phone: |
|
| Fax: |
|
| e-Mail: |
|
| Relationship to Nominee: |
|
| Today's Date: |
|
| |
|
