PO Box 7452
Stockton, CA 95267
Stockton
2021 Community Recognition Award
Nomination Form
DUE DATE: August 14, 2021
For handwritten responses use black or blue ink. Also, please limit your response to 2 pages.
1. Name, address, telephone number and email address of the nominee
Nominee’s name |
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Nominee’s address |
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Nominee’s telephone |
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Nominee’s email address |
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2. Please provide your name, address, telephone number, and email address as the nominator
Name |
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Address |
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Telephone |
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Email address |
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3. Area of nomination (circle one):
Education Business Community Service Arts Sports Science Military Legal Other (please list)
4. Explanation of why this person should be selected:
5. Awards and Accomplishments:
6. Other relevant information (education, work history, volunteer activities, etc.):
If you have any questions regarding the nomination or application process, please contact Linda Claramo at (410) 960-0081, lindaclaramo123@gmail.com or Gloria Nomura at (209) 483-8930 or golanomura@aol.com.
Copyright 2009 Filipino American National Historical Society-Stockton Chapter. All rights reserved.
PO Box 7452
Stockton, CA 95267
Stockton