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Virginia McKnight Binger
      Awards in Human Service

Submit a nomination today. Nomination deadline: April 4, 2012

Simply complete the form below to submit a nomination for the 2012 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.


ABOUT YOUR NOMINEE

Nominee's Name

Mr. Ms. Mrs.


Nominee's Street Address, City, State, and Zipcode


Primary telephone number, with area code


Alternate phone numbers (work, home, cellphone, etc.)


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?

Name of second organization with which the Nominee works (optional)

Nominee's position at the second 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?

Name of third organization with which the Nominee works (optional)

Nominee's position at the third 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

General information

1. 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)

2. 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


Note to lead nominator: Please immediately notify all co-nominators of this nomination, if you have not already done so. By listing co-nominators below, you introduce each individual into this selection process. Co-nominators may be contacted to verify their relationship with and support of this nominee.


Your Name

Mr. Ms. Mrs.


Your organization


Your Street Address, City, State, and Zipcode


Primary telephone number, with area code


Alternate phone numbers (work, home, cellphone, etc.)


Your email address (Will automatically receive copy of nomination.)


Your relationship to the Nominee


Name of Second Person familiar with the Nominee's contributions


Organization


Primary telephone number, with area code


Alternate phone numbers (work, home, cellphone, etc.)


Email address


Relationship to the Nominee


Name of Third Person familiar with the Nominee's contributions


Organization


Primary telephone number, with area code


Alternate phone numbers (work, home, cellphone, etc.)


Email address


Relationship to the Nominee


FOR OUR INFORMATION

How did you learn about these awards?

If "other," please explain (optional):



Review and Send.

Please review the form above before submitting your nomination. Note that the committee will review only those nominations that include all information requested above. Contact information will be used only in conjunction with this award, and will not be shared. When you are confident that the information you've entered above is clear and accurate, please click the "Submit" button below to send your nomination to The McKnight Foundation.

Please take special care to confirm you have entered your own email address correctly above. A receipt of your nomination will be sent to your email address exactly as entered.