Virginia McKnight Binger
      Awards in Human Service

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.)

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?

General information

1. Describe the work for which you are nominating this individual. Please give specific examples of how the Nominee directly serves people and how those activities affect people's lives. If this person is paid for this work, please describe how they go above and beyond the responsibilities of their job. (350-word limit)

2. Briefly list other ways the Nominee contributes to the community. (250-word limit)

3. Describe the person you are nominating. Include information about his or her personal qualities and background (such as special interests, family, or education) that supports your nomination. (250-word limit)

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

How did you learn about these awards?
Select one ------------------------------------------------ Newspaper / radio Word of mouth McKnight website McKnight postcard Other

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.