Chase Youth Awards Nomination Form

Category

Any adult or young person may nominate a youth/adult/group who meets the eligibility requirements. Please pick the category your nominee fits into:

Arts & CreativityCommunity ServiceCultural AdvocacyEntrepreneurshipEnvironmental ChampionInnovationLeadershipPersonal AchievementPhoenix AwardSocial AdvocacySportsmanshipJames E. Chase Adult Award

Divisions

Any individual or group of youth attending grades K-12 or equivalent are eligible for nomination. Multi-age groups will be placed in the division of the oldest member. Emphasis is given to significant contributions made within the last 12 months in Spokane County.

Please pick the division your nominee fits into:

Individual Elementary (K-6)Individual Middle (7-8)Individual Teen (9-12)Elementary School GroupMiddle School GroupTeen Group

Adult

Individual or group must be at least 18 years of age and no longer enrolled in high school. Nominees are judged on their community building efforts for Spokane County youth.

Tell us about the Nominee(s), in 3000 characters. Clearly address the following aspects in your nomination letter:

• Describe how you know the nominee and the length of your relationship.

• Describe the nominee's activities and character. Include any special attributes or challenges that set this nominee apart.

• Describe the impact this nominee has on other people and/or programs. Include any information about how much time, energy, or skill is involved.

• Describe the nominee's level of commitment or dedication.

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Information about the Nominee

Name of Individual/Group*:

Email Address*:

Phone Number (day):

Phone Number (cell):

Please add full mailing address for Nominee (Required)*:

Age(s):

Gender(s):

Grade(s):

School:

*Group Nominations: List group members on separate lines. Receipt of this list generates the electronic invitations and inclusion on potential awards. We are unable to make changes to incorrectly submitted names.

Information about the Nominator

Nominator's Name:

Nominator's Phone (day):

Nominator's Phone (cell):

Nominator's Email:

Please add the full mailing address for the Nominator (Required)*:

Nominator's Affiliation:

References for Nomination Verification

Please do not list anyone less than 21 years of age as nomination verifiers. Examples of acceptable verifiers are: parent, teacher, counselor, principal, etc.

1.) Name:

Phone Number (day):

Phone Number (cell):

2.) Name:

Phone Number (day):

Phone Number (cell):

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