Community Service Nomination Form


Nominee's Name________________________________________________


Nominee's Telephone #_____________ Nominee's Dept/Group_______


Your Name_____________________________________________________


Your Telephone #_____________Your Dept/Group__________________


Your e-mail address___________________________________________


What is your relationship with the employee you are nominating?

___ co-worker
___ employee's supervisor
___ employee is my supervisor
___ self
___ other (please explain______________________________________


Which award category are you nominating the employee for?

___ Outstanding Performance Award

___ Excellence in Community Service Award

___ Thrifty Nickel Award

1. In what ways has the nominee contributed substantially to the community?

2. What efforts has the nominee made to inspire others to help our community become a better place to live and work?

3. How has our community benefited from the work of the nominee?

4. How has the nominee demonstrated values consistent with the betterment of society?

5. Other comments.
If you have any questions about the selections you can visit the program description page or send e-mail to the employee recognition committee.

Return to Employee Recognition Program Home Page.