nomination form NOMINATION QUESTIONS: SUBMIT YOUR NOMINATION BY MARCH 1, 2010: NOMINATION CATEGORY:

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1 nomination form NOMINATION CATEGORY: Circle the community issue that fits the nominee s volunteer activity. Improving academic achievement Supporting early childhood development Improving public health Decreasing homelessness Supporting seniors, persons with disabilities and their caregivers Reducing violence and crime Strengthening non-profit leadership Caring for animals Protecting the environment Innovating agriculture Preserving arts/culture Other NOMINATION QUESTIONS: Answer each of the questions to the right using up to four single-sided sheets. Typed responses are preferred, but handwritten responses are acceptable. When answering the questions, focus on one volunteer activity that best represents the nominee s contribution, but also include brief details on other volunteer activities in which the nominee participates. Since judges will not know your nominee, be thorough. Include details of the community needs that the volunteer and the agency are addressing. Answer each of the following questions online at or using up to four single-sided sheets. 1. Please describe the volunteer activities that your nominee performs. 2. What role does the nominee fill at the agency (provides services to those in need, serves on the board, leads a committee, influences public sentiment/policy, etc.)? This form is also available online: SUBMIT YOUR NOMINATION BY MARCH 1, 2010: Mail this nomination form (make sure the opposite side is completed), along with answers to the questions above, to: United Way Volunteer Center, PO BOX 7548, Madison, WI You may also deliver it in person to the United Way Anderson Center at 2059 Atwood Ave., Madison. Nomination materials are available to complete and submit online at : 3. How does the nominee s work improve or change our community? In other words, what kind of impact is the nominee making? 4. How does the nominee embody the spirit of volunteerism (inspiring and leading others, overcoming personal/organizational challenges, using resources efficiently, etc.)? 5. Why should this nominee win a Community Volunteer Award?

2 UNITED WAY COMMUNITY VOLUNTEER AWARDS NOMINATION PACKET United Way of Dane County Volunteer Center PO Box 7548 Madison, WI Nominate a Dane County volunteer for a Community Volunteer Award! Nominations are due March 1, 2010.

3 united way community volunteer awards CELEBRATE YOUR VOLUNTEERS Think of the many people you know who give their time and talent to improve the lives of other people. Have you ever wanted to say Thank You but weren t quite sure how? The United Way Community Volunteer Awards give you a chance to recognize the individuals, families, groups and businesses who strengthen our community through volunteering! Four nomination categories accommodate any indivudal or group: adult, youth, family/ group, and business (a Dane County company with a volunteer program). All nominees will be recognized and winners will be announced at the Community Volunteer Awards luncheon on April 22, 2010 at the Madison Concourse Hotel and Governor s Club. FAST AND EASY NOMINATION ONLINE All volunteers at all Dane County not-for-profit agencies are eligible to be nominated. NOMINATE SOMEONE TODAY Nominations may be submitted online, delivered in person or mailed until March 1, Community Volunteer Award winners pose with Wisconsin s First Lady, Jessica Doyle

4 eligibility To be eligible for selection in the United Way Community Volunteer Awards: Submit the nomination form and answers to the essay questions in this packet. Nominee volunteer activities may take place at any not-for-profit organization in Dane County that serves the community at large. Volunteer service must be unpaid, but may be performed on work-release time or for student course credit (reimbursements for out-of-pocket expenses, like travel, are acceptable). Employees of United Way, CUNA Mutual Group, Group Health Cooperative, Physician s Plus Insurance, and St. Mary s Hospital, judges and their families may not participate as a nominator or nominee. Nominees may not be selected as a winner for two consecutive years. Judges decisions are final. Join us at the Community Volunteer Awards Luncheon Dane County s premier volunteer recognition event! Thursday, April 22, :30 AM - 1:00 PM Madison Concourse Hotel and Governor s Club Watch for registration info at:

5 faq Who chooses the award winners? Winners are selected by a group of community leaders who have lots of experience volunteering. Should I tell the volunteers they ve been nominated? Yes! It is a great honor to be nominated for a United Way Community Vounteer Award. What happens after a volunteer is nominated? After the nomination form is received at the United Way Volunteer Center, a congratulatory letter will be sent to the nominee. Later, the nominee will receive an invitation to the awards luncheon on April 22, as a guest of United Way, CUNA Mutual Group, Group Health Cooperative, Physician s Plus Insurance, and St. Mary s Hospital. Can I submit more than one nomination? Yes, as long as the nominees do not perform the same function within the same organization. When will the winners be announced? At the Community Volunteer Awards luncheon on April 22 at the Madison Concourse Hotel and Governor s Club. Are only volunteers at United Way partner agencies eligible? Volunteers at ANY not-for-profit organization in Dane County can be nominated as long as they meet eligibility requirements to the left. I don t have a photo. What do I do? You will be notified of dates that the nominee can come to United Way to have their photo taken.

6 nomination form 1. NOMINATION TYPE (Check one) Adult Youth Group/Family Business 2. NOMINATOR INFO Name: Organization or relationship: Daytime phone: Mailing address: City/state/zip: Today s date: Your signature: 3. NOMINEE INFO Name: Phonetic spelling: If youth candidate, age or date of birth: Nominee address: Daytime phone: Nominee mailing address: Nominee city/state/zip: If group, family, or business, primary contact name and number in party: 4. VOLUNTEER SERVICE & AGENCY INFO Name of agency: Name of Agency Director Agency phone number: Agency mailing address: Agency city/state/zip: Does the agency have 501(c)3 status? Number of years volunteer has served: Hours donated by volunteer per month: 5. NOMINEE PHOTO Send a close-up, digital photo to kbechtel@uwdc.org If no photo is available, see FAQ page. Nominations must be delivered or postmarked by March 1, 2010