Larry Saunders Award Application

 

 

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2019 Nomination Form Larry Saunders Service Award

 

The City of Lakewood, in partnership with Lakewood Community Foundation Fund (LCFF), is accepting nominations for the

 

2019 LARRY SAUNDERS SERVICE AWARD

 

to honor a citizen or organization for extraordinary service to community.

 

PLEASE LEGIBLY COMPLETE and deliver this Nomination Form, in person or by mail, to the Reception Desk, First Floor, Lakewood City Hall, 6000 Main Street, SW, Lakewood, WA 98499, to arrive before the

NOMINATIONS DEADLINE: 5:00 PM, FRIDAY, SEP 27, 2019.

 

NOMINEE

FULL NAME ______________________________________________________

                              (Person or Organization proposed for special recognition)

 

ADDRESS _______________________________________________________

                              (Mailing address)

 

CONTACT _______________________________________________________ 

                              (Phone & email address)

 

NOMINATOR

FULL NAME ______________________________________________________

                              (Person making nomination)

 

ADDRESS _______________________________________________________

                              (Mailing address)

 

CONTACT _______________________________________________________ 

                              (Phone & email address)

 

RELATIONSHIP TO THE NOMINEE: __________________________________

 

______________________                          ________________________

PLEASE SIGN                          AND            CONFIRM DATE SUBMITTED

 

 

          DEADLINE FOR NOMINATION IS SEPTEMBER 27, 2019

 

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2019 Nomination Form Larry Saunders Service Award

 

NARRATIVE - TELL US WHY YOU BELIEVE THE SERVICE OF YOUR NOMINEE IS SPECIAL AND DESERVING OF COMMUNITY RECOGNITION:

          (Please limit your nomination narrative to one page or 250 words)

You may attach additional information/image if deemed essential to support or complement your NARRATIVE.

 

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          DEADLINE FOR NOMINATION IS SEPTEMBER 27, 2019

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2019 Nomination Form Larry Saunders Service Award

 

The AWARD will be presented at City Hall on January 21, 2020, together with a Special Grant to a qualified (not-for-profit) Lakewood organization selected by the Award recipient, available and present to receive this contribution.

 

Please provide name and contact information for the qualified Lakewood organization designated to receive the Award's associated Special Grant:

 

ORGANIZATION __________________________________________________

                              (Name of qualified organization re separate Award Grant)

 

ADDRESS _______________________________________________________

                              (Mailing address)

 

QUALIFYING REFERENCE _________________________________________

                                                  (EIN or IRS Letter of Determination) (#1)

 

CONTACT _______________________    ______________________________

                              (Name)                                      (phone & email address)

 

COORDINATION Approval and Presentation of the LARRY SAUNDERS SERVICE AWARD is predicated upon reasonable expectation that parties involved will attend and participate, or be represented, at the City Council meeting indicated (above). For purposes of agenda and preparation, related information will be confirmed during the preceding month. It is assumed that all parties concerned shall be available to respond or provide timely notice (#2).

 

ADDITIONAL INFO Please attach or reference specific supporting information, documents, news or photo/image as may help a fair and valid determination for the Award (#3).

 

THANK YOU For taking the time to help MAKE A DIFFERENCE for Lakewood.

 

NOTES:

#1. Any established 501(c)(3) organization dedicated to provision of a public service/benefit within City of Lakewood.

#2. Receiving organization shall participate by providing a representative to receive the check.

#3. All supplemental materials provided will become part of the Application and may not be returned without specific request.

 

DEADLINE FOR NOMINATION IS SEPTEMBER 27, 2019