STEP 1 - Please select the Division:
Individual Business/Organization  Project  
Only individuals will be considered for the Jefferson Awards.

STEP 2 - Please select the Category:
Arts Education Government/Public Service 
Health/Social Service  Neighborhood/Community

STEP 3 - Please provide the following information.
Nominee Information:
Nominee's First Name:   Last Name:
Name of Project, Business/Organization:
Address 1:
Address 2:
City:      State:    Zip:
Work Phone:      Home Phone:
E-mail:

Nominator Information:
First Name:     Last Name:
Address 1:
Address 2:
City:      State:    Zip:
Phone:
E-mail:

STEP 4 - Nomination Criteria:
Please provide a brief overview and answer the following questions thoroughly about the nominee by typing two or three paragraphs for each of the five questions below.  The Selection Committee appreciates all of the information you submit and asks you to provide as much information as possible in a concise manner.  Please do not use any HTML code or tags.

Please provide a one to two sentence overview of your nominee:

Question #1: How has the nominee made a commitment to bettering the community?

Question #2: How has the nominee inspired others to a common vision?

Question #3: How does the nominee practice collaborative leadership?

Question #4: How does the nominee embrace diversity?

Question #5: How has your nominee gone above and beyond the call of duty 
to impact the community beyond the normal job duties?