Nominee(s) Name
*
First Name
Last Name
Nominee(s) Name
First Name
Last Name
Nominee's Email
*
Nominee's Phone
*
(###)
###
####
Nominee's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Your Relationship to the Nominee(s)
*
Form Submitted By
*
First Name
Last Name
Agency/Corporation (if applicable)
Submitter's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Submitter's Email
*
Submitter's Phone
*
(###)
###
####
Required Criteria
*
How has this person/couple demonstrated a lifelong commitment to improving the quality of life in their community? Please cite specific examples.
*
List organizations in which the nominee (s) has shown active involvement and demonstrated leadership in multiple community organizations. Please include activities and offices held in each.
*
Explain efforts, activities and leadership which have made a positive, sustained difference in the community.
*
List volunteer recognition for each nominee, including recognition and year of acceptance (if known).
*
Nominee models Sage attributes of ‘wise through reflection and service.’ Please provide examples.
*
Please list nominee’s social influence and community organization affiliations.
*
