CVA – Adult Individual or Group « United Way of Dane County

1. NOMINATION CATEGORY: Mark 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 or their caregivers
Reducing violence and crime
Strengthening nonprofit leadership
Caring for animals
Protecting the environment
Innovating agriculture practices
Preserving arts/culture
Other

If other, please list

2. NOMINATOR INFORMATION

Name:*

Organization or Relationship:*

Mailing Address:*

City/State/Zip:*

Daytime Phone:*

Email Address*

3. INDIVIDUAL or GROUP NOMINEE INFORMATION

Individual or Group Name:*

Phonetic Spelling:

Number of Volunteers:*

Nominee Primary Contact Email Address:*

Nominee Mailing Address:*

Nominee City/State/Zip:*

Nominee Phone:*

4. VOLUNTEER SERVICE

Name of Agency:*

Name of Agency Director:*

Agency Mailing Address:*

Agency City/State/Zip:*

Agency Phone Number:*

Number of years served:*

Hours donated per month:*

5. NOMINEE PHOTO

Please send a close-up, digital photo to kbechtel@uwdc.org. If no photo is available, please contact Kayla Bechtel at kbechtel@uwdc.org or (608) 246-4384.

NOMINATION QUESTIONS:

Please answer the following questions in regards to your nominee.
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.

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, leads a committee, influences public sentiment/policy, etc.)?*

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 Communtiy Volunteer Award?*

CVA – Adult Individual or Group

Community Volunteer Awards - Individual/Group Form