HomeMy WebLinkAboutCitizenship Award Nomination Form2006MOUNDS VIEW CITIZENSHIP AWARD
2006 NOMINATION FORM
Name of Nominee:
Title (optional):
Address:
City, Zip Code:
Phone: Fax:
Email:
Nominated By:
Organization (if any):
City, Zip Code:
Phone: Fax:
Email:
(Attach additional pages as necessary).
How long have you known the nominee and in what capacity?
Describe briefly specific contributions the nominee has made to the community as it relates to the Mounds View Citizenship Award criteria:
What special circumstances make the nominees’ achievements outstanding?
Share any additional information about the nominee you would like considered:
Application Process
You are encouraged to submit one or more of the following documents to support this nomination:
Background information.
Letters of support from different community agencies and individuals.
Any other material that demonstrates the nominee’s contribution to the community as it relates to the award criteria.
Nominations must be in writing and may be supported by letters and other documentation. All materials must be received by the close of the nomination period, and become the property
of the City of Mounds View.
Selection Criteria
In assessing the candidates for the Mounds View Citizenship Award, the award selection committee will look for an individual who has given unselfishly of his or her time to fight for
a just cause that he or she believes will result in a better community.
The award selection committee (the Mounds View City Council) will identify an exceptional individual who meets the criteria below. (In scoring, 5 points are possible for each criterion)
1.) Courage
Exemplifies courage and determination to follow one’s own values.
2.) Initiative
Demonstrates drive and initiative in his/her approach and overcoming challenges along the way.
3.) Time Commitment
Volunteers a significant amount of time and energy to further a cause or issue; more than just financial contributions.
4.) Effectiveness
Generates positive results for the community.
5.) Unselfishness
Does not expect anything in return for his/her actions, i.e. financial compensation, fame, or political notoriety.
To nominate an individual
All nominations must be received by Wednesday, February 28, 2007.
Complete the nomination form.
Gather letters and documents to support the nomination.
Send all nomination materials to:
The City of Mounds View Citizenship Award
2401 County Highway 10
Mounds View, MN 55112
Ph: (763) 717-4000 Fax: (763) 784 – 3462
If you have any questions about the nomination process, please call our offices at: 763-717-4000.