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2. Instructions

   Criteria and Specifications:

   The criteria against which applications will be judged are:

   • The benefit to the community

   • The number of people affected positively by the nominee

   • The length of service in connection with the activity 

   Specifications:

   • An official entry form with supporting narrative must be submitted for consideration by the Town Board. 

   • Your description of the nominee's accomplishments will be crucial to the selection process.

   • All nominees must reside within the Town of Fallsburg, New York.

   
   

6. Person Making the Nomination Name*
7. Person Making the Nomination Email Address*
9. Person Making the Nomination Address*
11. City*
12. Zip Code*
14. Person Making the Nomination Phone Number
18. Nominee Information Area
20. Nominee Name*
21. Nominee Email Address
23. Nominee Address
25. Nominee City
26. Nominee Zip Code
28. Nominee Phone Number*
30. Nominee Accomplishments*

    Please describe the nominee's accomplishments by addressing each of the following points, using no more than three pages.

    1. Briefly describe the nominee's activity (indicate what the person or group has done, how it was accomplished, where this activity happened, and when the contribution was made.)

     2. Describe how long the nominee has been involved with this activity. 

    3. Describe how the community has benefited from this activity. 

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field