Nominations

Nominee details

Name

First

Last

Nominee's Address

Address Line 1

Address Line 2

City

State

Zip Code

Nominee’s phone number:

Nominee’s email address:

Award criteria

When making your nomination, please provide short statements describing how the nominee meets the following criteria. Where possible, provide examples to support the statements. (Please limit response to space provided)

1. Why are you nominating this person(s)?

2. What is their situation that makes them worthy to be nominated?

3. How have they attempted to help themselves?

4. How will GPL’s assistance benefit them?

Nominated by

Name

Organization

Address

Address Line 1

Address Line 2

City

State

Zip Code

Telephone

Mobile

Email

Relationship to nominee

Date

Signature

References

Name of friend 1:

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone number

Email address

Name of friend 2:

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone number

Email address

Nominations

NOMINATIONS

Nominee details

Award criteria

Nominated by

References