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Dublin Chamber Civic Foundation Community Champion Awards Nomination Form

The Community Champion Awards recognize young citizens (in grades 4 – 12) and staff of the Dublin City School district who engage society through leadership and service, and honors those who exemplify the best of volunteerism, character, leadership, and a sense of caring and responsibility for others.
 

Guidelines:

You may nominate as many Dublin City School students and staff members as you wish. Please submit a separate nomination for each individual. 

  • Groups are not eligible for nomination, although participation in a group can be mentioned in the nomination of an individual.

  • All nominations will be reviewed by Dublin City Schools staff.

  • Please include any information you feel will help the review panel understand why you believe your nominee should receive a Community Champion Award.


I would like to nominate the following individual for the Community Champion Awards: (If nominee is a student, please provide their given name and grade as registered in the Dublin City School District.)
First Name of Nominee
Last Name of Nominee
Nominee is a
Select Grade Level or Staff
Nominee School Name
Please tell us why your nominee deserves this award in 1,000 words or less. Please be descriptive. (You may copy and paste from a Word document.)
Nomination
If your nomination includes service groups or programs that are lead by another person besides yourself, please list their names, affiliation and contact information to the best of your ability below. This helps us verify all the great work our Community Champion Award nominees do.
Additional Information for Service Groups
Nominator Information
(Note: All nominator information is kept anonymous from the nominee, and is requested for verification purposes.)
Your Name
Your Street Address
Your City
State
Your Zipcode
Your Email
Relationship to Nominee
Other Relationship
Additional Comments




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