Chamber Alliance of Lake County

Community Service Awards Nomination Form

  • COMPLETED FORMS: Delivered by March 17, 2017 
  • Complete a separate form for each category nomination.
  • Previous awardee’s are NOW eligible to be nominated for any category other than the category for which they had been previously recognized.
PURPOSE: To annually recognize and publicly honor outstanding community service in the fields of: 
• Arts/Cultural
• Leadership
• Humanitarian
• Hall of Fame Business Award
• Public Service
• Public Safety
• Education
• Sports/Athletics
• Enterpreneur
Business  Achievement: 
   • Small (1‐11 employees) 
   • Medium (12‐39 employees) 
   • Large (40+ employees) 
   • Youth Award
Submit The Form Below or Click Here To Print Nomination Form
NOMINEE:  
Category
  *Name
  *Business/Profession
Address
Phone
Email
REASONS FOR NOMINATION (please give examples)
  *1
2
3
AWARDS RECEIVED BY NOMINEE THAT RELATE TO CATEGORY
1
3
  2
  4
CLUBS, ORGANIZATIONS, AND POSITIONS THAT RELATE TO CATEGORY
1
2
3
4
Note: one page of additional comments may be attached, 4000 characters max
 
characters left
NOMINATOR  
  *Name
Address
  *Phone
  *Email
 
.   Enter Security Code

 

 

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