2025 Youth Award Nomination Form

Nominee Information

Tell us about your nominee. Please complete all fields in the application. Providing detailed information will assist us in the selection process.

Date*

Nominee's Name*

First Last

Nominee's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nominee's Phone*

Nominee's Email*

Nominee's Gender*

If student - name the school attending and grade level. If not a student please enter N/A.*

County in which school attending is located.

Nominee's Date of Birth*

Nominee's age as of March 4, 2025*

Please enter a number from 12 to 20.

Nominator's Information

Nominator's Name*

First Last

Noiminator's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Nominator's Phone*

Nominator's Email*

Nominator's Relationship to Nominee*

Signature of Nominator

Name*

By typing my name in the space below I stated that to the best of my knowledge, all the information provided in this application is true and reflects the nominee accurately. I have made note of specific information about the nominee that needs to be kept confidential.

First Last

Tell us why your nominee deserves this award.

Please be as specific as you can and use additional sheets if necessary. Pertinent supplementary material may be included. Nominations with very brief, illegible or incomplete information may not be given as much consideration as thorough nominations. Provide as much information and as many specific examples as possible. (Examples might include: overcoming physical, emotional, or other challenges; providing financial or emotional support to family and friends; care of sick or elderly sibling, parent, or friend; providing positive leadership and role modeling for other youth; positive behavioral changes; and community involvement.)

1. Describe the personal adversity, difficult environment or limitations your nominee has overcome.*

2. What were the key factors that helped your nominee turn his or her adversity around?*

3. In what ways has your nominee benefited other youth, their family or their community?*

4. Why do you feel your nominee should receive this award?*

Your County

Youth Initiative

01.

Help Me With...

02.

03.

Youth Initiative

2025 Youth Award Nomination Form