Service Above Self Youth Award Nomination Form

Service Above Self Youth Award
Nomination Form
TO NOMINATE AN INDIVIDUAL:
*Required Information
*SCHOOL (please indicate school the nominee attended in the 2013-14 school year) ___________________________________
*NOMINEE CATEGORY INFORMATION (please circle the grade level of your nominee during the 2013-14
school year):
K-5
Middle
High School
* NOMINEE NAME ____________________________________________________________________________________________
* ADDRESS__________________________________________________________________________________________________
*CITY___________________________________________________________________ STATE___________ ZIP_______________
*PHONE (______)________________________ GRADE _____________NUMBER OF HOURS_________________ AGE____________
EMAIL ____________________________________
ORGANIZATION (organization for which Nominee volunteers):
* NAME OF ORGANIZATION_______________________________________________________________________________________
* PHONE (______)________________________________ CONTACT PERSON_______________________________________________
ADDRESS____________________________________________________________________________________________________
CITY___________________________________________________________________ STATE___________ ZIP_________________
E-Mail___________________________________________________________
NOMINATOR:
* NAME_______________________________________________________________________________________________________
*ADDRESS_____________________________________________________________________________________________________
*CITY_______________________________ STATE___________ ZIP_____________ *PHONE ( ____ )___________________________
*E-Mail (if applicable) _____________________________________________________
Please print or type answers to the following using a separate sheet(s) of paper:
Activity: Provide a detailed description of the volunteer service and the following:
Achievement: Did nominee accomplish desired results? Explain
Time: Number of hours nominee has volunteered for organization.
Need: Describe need for nominee's service(s).
Challenges: Did nominee overcome challenges (physical or mental handicaps, limited resources, public perception)?
Impact: Describe impact or difference nominee's service made to the community. How many people were affected?
Other: Why do you believe your nominee deserves the Service Above Self Award?
ROWAN ROTARY AND
ROWAN COUNTY UNITED WAY
SERVICE ABOVE SELF YOUTH AWARD
NOMINATION FORM INSTRUCTIONS:
The Rowan Rotary Club, joining hands with the Rowan
County United Way, will present awards for community
volunteer service based on the Rotary International motto
"Service Above Self." These awards will be for the 20132014 academic year.
Individuals or groups may nominate more than one
candidate.
Winners and finalists will be announced and honored
during an awards ceremony at 6:30pm on Thursday,
December 11, 2014 at Keppel Auditorium located at
Catawba College.
AWARDS
Three individuals and three organizations will be
recognized in each division: elementary, middle and high
school level. Student winners in each division will receive a
medal and a check with a matching amount going to their
school: First Place $250, Second Place $100, Third Place
$50. Groups/Organizations that have tax-exempt status
under section 501(c)(3) are eligible for the following: First
Place $500 contribution and a plaque, Second Place $100
contribution, Third Place $50 contribution. All nominees
will receive a framed certificate for their service.
ELIGIBILITY
Nominee(s) group volunteer organization must provide
services for the community at large.
Nominee(s) organization must qualify for a 501(c)(3) status
to receive a contribution.
Volunteer service must be performed without pay.
Volunteer service must have occurred
between August 1, 2013 and November
14, 2014.
Nominees must be residents of Rowan County, but
volunteer service may be inside or outside the county.
Rowan Rotary and Rowan County United Way Staff can
not judge. Members of the judging panel, the Chairperson
of the panel or their families can not be nominated.
SEND ALL ENTRIES TO:
Dr. Jerry Chandler
Rowan County United Way
1930 Jake Alexander Blvd. W., Suite B
Salisbury, NC 28147-1186
FOR MORE INFORMATION CALL:
Jackie Harris
Rowan County United Way
704-633-1802
Nomination must be filled out completely and legibly.
A maximum of 3 attachments is allowed to accompany the
nomination form (Example: two reference letters, one
newspaper article, etc.).
No videotapes, scrapbooks, photos or binders allowed (will
not be given to judges nor returned).
Judges may request additional information from nominee,
nominators or agencies.
Judges' decisions are final.
Nomination and attachments become property of the
Rowan Rotary and Rowan County United Way, and may be
used in other awards.
HELPFUL TIPS:
Be specific and concise when possible.
Focus on one program that most exemplifies the nominee's
service. Secondarily, describe the other volunteer work or
leadership positions as they rank in importance.
Assume judges know nothing about the nominee, the
organization or community.
Local judges may be
unfamiliar with the organization, so tell the story as you
would to a stranger.
Well-written nominations score higher with judges. If
necessary, ask for help from someone you know, who has
excellent writing skills.
Have another person proof nomination form for errors or
omissions.
Make sure all areas of nomination form are filled out
properly.
To download a nomination form or to nominate online,
please visit our website at:
www.rowanserviceaboveself.com
Nomination forms must be submitted or
postmarked no later than November 14,
2014. There will be NO extensions on the
deadline this year.