Asset Champions Nomination Form

ADULT ROLE MODEL AWARD

Nominees must be individuals over 24 years of age who demonstrate significant efforts to advance young people’s academic, physical, emotional, social, and/or cultural success.

Award recipients will be selected based on the answers to the questions in the 'About the Nominee" section below. Please consider preparing the answers in advance to give the most complete information you can about your nominee. Then cut and paste your responses into this form.
Nominee's Name Nominee's Name First Last
Nominee's Organization and Title (if applicable)
Nominee's Address Nominee's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Nominee's Phone Nominee's Phone - ### - ### ####
Nominee's Email
ABOUT THE NOMINEE:

Nominees in this category must be an individual over 24 years of age and have modeled, inspired or demonstrated responsible behavior for other young people. Award recipients will be selected based on the answers to the question below.

Here are some guidelines as to what makes a good nomination:
• Provide specific examples of the impact of the nominee’s work.
• Outline what sets this nominee apart from others doing similar work. What makes their efforts unique?
• Consider how this nominee serves as a role model for others.
• Provide enough information. Strong nominations usually include 250-500 words for each question.
• Photos, videos, websites, links, and other additional documentation will not be reviewed.
1. How does the nominee model responsible, positive behavior for young people?
2. Provide at least two specific examples of the nominee’s impact on young people and the community at large as a result of their asset-building efforts.
REFERENCES:

Please provide contact information for two other people in the community who are knowledgeable about the nominee’s efforts.
Reference #1: Name Reference #1: Name First Last
Reference #1: Organization and Title
Reference #1: Address Reference #1: Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Reference #1: Phone Reference #1: Phone - ### - ### ####
Reference #1: Email
Reference #2: Name Reference #2: Name First Last
Reference #2: Organization and Title
Reference #2: Address Reference #2: Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Reference #2: Phone Reference #2: Phone - ### - ### ####
Reference #2: Email
NOMINATOR INFORMATION:

Please provide contact information for yourself so that we can contact you with any questions about your nomination and inform you if your nominee receives an award.
Your Name Your Name First Last
Your Organization and Title
Your Address Your Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Phone Your Phone - ### - ### ####
Your Email

Confirm Email Address
Nominations must be received by October 31.

All nominations will be reviewed by a panel of community volunteers as well as Project Cornerstone board members and staff.

Award winners and their nominators will be notified by January. All Asset Champions Awards nominees and recipients will be formally honored at next year's Project Cornerstone Asset Champions Awards event.

Asset Champions Nomination Form

Asset Champions Nomination Form

ADULT ROLE MODEL AWARD

ABOUT THE NOMINEE:

REFERENCES:

NOMINATOR INFORMATION:

Nominations must be received by October 31.