2010 Volunteer of the Year

Required information is marked by an asterisk (*)

This is a nomination for the following category
(Select only one category per form):

Facility Name: *

Address:

City, State Zip:

Phone:

Fax:

E-mail: *

Nomination Submitted By:
Name:

Title:

Accurate and Full Name of Nominee/Group:

Contact for Group:

Address:
(This address will be used to mail Luncheon invitation):

City, State Zip:

Length of volunteer service at nominating facility (in years):

How frequently does the volunteer(s) visit the facility (per week or per month):

Has the volunteer recruited additional volunteers for your facility?:

In no more than 250 words (total), explain what makes your Volunteer of the Year nominee special. In your discussion, please answer the following questions:

How does the volunteer help residents reach their potential?
In what ways has the volunteer helped residents become active members of the facility community or the larger local community?
What sacrifices have been made by the volunteer — or what special difficulties have been overcome — that make his or her contributions unique?
Have residents, family members or employees acknowledged the value of your nominee’s contributions? - Yes - No
Describe briefly any programs developed by the volunteer.

DO NOT REFER TO NAME, AGE OF VOLUNTEER OR NAME OF FACILITY OR CITY IN WHICH S/HE LIVES.

Excerpts of your comments will be included in the Volunteer Luncheon Program.

Message: