Spirit of Youth Recognition Form

MS Word version for submission via email  

Note: do not press the Enter key until you're ready to submit the form. Use the Tab key to move from field to field.

Person / Group being recognized		Person submitting this form
Name:		Your Name:
Address:		Address:
City / Zip:	/	City / Zip:	/
Nominee Phone:		Day Phone:
Email:		Evening Phone:
School:		Email:
School Address:		If a group, name of Adult Advisor:
School City / Zip:	/	Advisor Day Phone:
School Phone:
School District:
Other References
Reference #1 Name		Reference #2 Name
Reference #1 Phone		Reference #2 Phone

Please include as much detail and description as possible when answering the following questions. The teen action council will use this information to select media stories and annual recognition winners.
This nomination is for what category? (select up to two categories--use ctrl-click to select multiple)	Business and Government Cultural Pursuits Faith Based Service Fine arts Lifesaver and Prevention Overcoming Challenges Science and Environment Service to Community Service to Peers Service to Young Children Technology and Media
Describe youth-led or youth-initiated activities in which the person/group is involved:
Describe HOW this person or group helps others or improves the quality of life in your community. Include qualities that make this person/group interesting, unique or an inspiration to others:
Does this youth-led project address a social problem, conflict or problem issue in the community? If yes, please describe:
Date(s) of youth-led event or activities.
How did you hear about Spirit of Youth?
Please enter the digits as you see them on screen--this "Human Validation" helps prevent automated SPAM submission.