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Nominate a Youth Change Maker!
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1.
What is your name? (first and last)
(Required.)
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2.
If you are an adult, what is your job title/occupation? If you are a youth, what grade are you in?
(Required.)
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3.
What is your email address?
(Required.)
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4.
What is your phone number?
(Required.)
Nominee's Information: Please enter the information of the young person you are nominating for the award. Email and phone number will only be used to communicate with them about their nomination.
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5.
What is their name? (first and last)
(Required.)
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6.
What grade are they in?
(Required.)
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7.
What is their email address?
(Required.)
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8.
What is their phone number?
(Required.)
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9.
What is your relationship with the person you are nominating? (teacher, supervisor, etc.)
(Required.)
Reasons you are nominating this person:
10.
Select the category or categories you are nominating this person for (please select at most two options).
Conflict Resolution: Helping Peers Come to Peaceful Solutions
Positive Values: Demonstrating Integrity, Honesty, and Responsibility
Fosters Safety and Belonging, Contributing to Safe and Inclusive Spaces For Their Peers
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11.
Why have you selected this individual for this category? Briefly describe the nominee’s community involvement, volunteer activities, impact on children, youth and families in the City of Alexandria.
(Required.)
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12.
Describe how the nominee has made the community a better place for children, youth and families in Alexandria, including any programs, projects or other efforts that impact children and youth.
(Required.)
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13.
Provide a biography of nominee (200 characters or less).
(Required.)
14.
Optional: Additional comments that you deem relevant to the nominee’s application, such as, but not limited to past awards, membership on boards and commissions, etc.
