Voice of the Community Nomination Form

2018 Voice of the Community Award

Make your Voice of the Community Award online nomination here!

APPLICATION DEADLINE: All applications must be received by 5 p.m., August 22, 2018.

When we receive your application, we will send you an email within five business days. If you don’t receive an acknowledgement, contact us at Voice@kser.org.

About the Person Completing This Form

Name: *

Phone: *

Email Address: *

Address: *

City: *

State: *

Zip: *

How Do You Know the Nominee?: *

Application Category

Check one: *

Community Impact: social, environmental, educational, civic engagement

Cultural Impact: arts and entertainment, enrichment, education, building cultural awareness

About the Nominee

Check one: *

Individual

Organization

Business

Name of Organization or Business

Contact Name (Complete only if this is a business or organization nomination):

Contact Title:

Phone Number:

Email Address:

Address:

City:

State:

Zip:

Name of Individual

Name (Complete only if this is an individual nomination):

Phone Number:

Email Address:

Address:

City:

State:

Zip:

For what community or cultural concern did this person, organization or business create awareness? Community concerns should focus on social, envirionmental, educational or civic engagement; cultural concerns should focus on arts & entertainment, et al.: *

How did this person, organization or business give voice to the community or cultural concern?: *

When did this take place?: *

What was the outcome or result? Please provide specific examples about who or what was impacted, in what ways and for how long. Also, include details if the individual, business or organization rallied others to help create a positive impact.: *

Please provide supporting documentation such as websites, links to news stories, or testimonials. Attach relevant documentation as needed.:

CAPTCHA

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Copy the characters (respecting upper/lower case) from the image.

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Voice of the Community Nomination Form

2018 Voice of the Community Award

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