Voice of the Community Nomination Form

2013 Voice of the Community Award

2013 AWARD GUIDELINES
• You can nominate an individual, organization or business that has positively affected residents within the KSER coverage area (primarily Snohomish and Island counties, north King County, and portions of Jefferson and Skagit counties).
• Positive results should have either a community or cultural impact in one or more of the following focus areas:

o Community impact: social, environmental, educational, civic engagement
o Cultural impact: arts and entertainment, enrichment, educational or building cultural awareness

• Not eligible:

o Self-nominations
o KSER employees or regular volunteers

APPLICATION DEADLINE: All applications must be received by 5 p.m., July 1, 2013.

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 focuse 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.:

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