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.
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