VMB Award Nomination Form

Submit a nomination today.

Simply complete the form below to submit a nomination for the 2013 Awards in Human Service. Before you get started, you may first want to gather together:

Contact information for the person you are nominating, including address, telephone numbers, email, etc.
Supporting information about your nominee's work and its affect on others; additional ways in which your nominee contributes to the community; and personal qualities and background of your nominee that support your nomination.
Contact information for two other people, in addition to yourself, who are familiar with your nominee's contributions. Nominators must represent at least two separate organizations.

More information about award eligibility and the review process is also available online. Please note that nominees must be residents of Minnesota, and nominees cannot nominate themselves.

The selection committee will review completed nominations only; the committee will not consider other materials or letters of support.

Nominee Information

Prefix: * Name: * Nominee's Street Address, City, State, and Zipcode * Primary telephone number, with area code Alternate phone numbers (work, home, cellphone, etc.)

Nominee Organization(s)

Please list up to three organizations for which this nominee performs services.

* Name of organization with which the Nominee works * Nominee's position at the above organization * How many hours (weekly, monthly, or annually) does the Nominee spend on this work? * Is the Nominee paid for this work? * How long has the Nominee done this work?

About the Nominee's Work

* Describe how the Nominee directly serves people and how people's lives are changed. If the Nominee is paid for this work, please describe how the nominated work exceeds their paid job responsibilities. (500-word limit) * Describe the Nominee's personal qualities, interests, or background that help them to attend, unite, and empower people so effectively. (250-word limit)

About the Nominators

Primary Nominator

Prefix: * Name: * Organization: * Street Address, City, State, and Zipcode * Primary telephone number, with area code Alternate phone numbers (work, home, cellphone, etc.) * Email address (First nominator will automatically receive copy of nomination.) * Relationship to the nominee

Co-nominator 1

Co-nominator 2

For Our Information

* How did you learn about these awards? If "other," please explain (optional):

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