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The David Chow Humanitarian Award Nomination Process

Please note the cut off DATE for 2011 NOMINATIONS is September 15, 2011

Directions: To enter a nomination on-line, this form must be completely filled out and must be:

  • Written by a Nominator who is in a position and aware of the Nominee’s humanitarian service.
  • Written with a thorough and accurate description of the Nominee’s humanitarian service.
  • Accompanied with accurate identification of the individual Nominee.
  • Accompanied with three (3) Nominee Endorsements.
  • E-Mail forms by clicking the SUBMIT BUTTON below.
Directions: To enter this form by fax or mail, please print using the PRINT FORMS Button and follow the same instructions as above. Fax and mailing information is on the printable form.
NOMINATION FORM

Nominee's Information

Nominee's Full Name:*

Nominee's Birth Date:*

(mm/dd/yyyy)

Nominee Street Address:*

Nominee City:*

State or Province:*

Zip/Postal Code:*

Country:*

Nominee's Office Telephone:*

Nominee's Cell Phone Number:

Nominee's Fax Number:

Nominee E-Mail:*
Nominator's Information

Nominator's Full Name:*

Nominator's Birth Date:*

(mm/dd/yyyy)

Nominator Street Address:*

Nominator City:*

State or Province:*

Zip/Postal Code:*

Nominator Country:*

Nominator Office Tel.:*

Nominator Cell Phone:

Nominator Fax Number:

Nominator E-Mail:*

1. Describe the Nominee’s humanitarian service and how this service benefited individuals within the community.*

2. What factor/characteristics make this Nominee exceptional? *

3. The number of people helped by Nominee?:*

4. How much time does the Nominee devote to his/her humanitarian service?*

 
Over-time - over 40 hours per week.
Full-time - 40 hours per week. 
Part-time - up to 32 hours per week.
Monthly - up to 8 days a month.
Semi-annually - up to 12 days every six months.
Annually - up to 12 days per year.

5. How does the Nominee finance his/her humanitarian service? *

 
Receives payments
Requires no monies 
Self-funds all services
Receives outside funding
 Select all that apply and please explain:

When did Nominee begin this humanitarian service?*

 Month Year

Today's Date:

Month Day Year

E-Mail Affirmation - By checking the "I Agree" button, you hereby swear that all of the above statements are true to the best of your knowledge.*

 I agree    I disagree
 
  Upon Submitting this form, please have 3 Endorser's fill out the Endorsement Form.
*required information  
   
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©2010 The David Chow Humanitarian Award Foundation All Right Reserved.