The Ebby Rose of Distinction Awards 2008

  Nominee:

First and Last Name:

Title (optional):

Organization:

Predominant Area of Volunteer Work:

Home or Work Address:

City:

State:

Zip Code:

Home or Work Phone:

Home or Work Fax:

Home or Work E-Mail:

  Nominated By:

First and Last Name:

Organization:

Home Address:

City:

State:

Zip Code:

Home or Work Phone:

Home or Work Fax:

Home or Work E-Mail:

  Additional Information:

How long have you known the nominee and in what capacity?

Briefly describe specific contributions the nominee had made to the community. Please be as detailed as possible:

What special circumstances make the nominees' achievement outstanding?

Share any additional information about the nominee you would like considered:

Please provide a brief biography of the nominee, including demographic information, marital and family status, highest education attained, employment history, involvement in civic and community organizations involved, awards and honors recieved:

  Please provide us one refrence, other than the nominator, we  may contact if necessary:

First and Last Name:

Relationship to Nominee:

Phone:

  Where did you learn about The Ebby Rose of Distinction  Award?

  T.V.

  Radio

  Newspaper

  Online

  Magazine

  Outdoor

  Direct Mail

  Friend

  Other  

I hereby attest that the information in this nomination for The Ebby Rose of Distinction award is correct and truthful to the best of my knowledge.