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2. NOMINEE INFORMATION

   Please provide whatever information you may have regarding the nominee and how to contact the individual(s).

4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Email Address
18. CONTACT INFORMATION FOR PERSON SUBMITTING THE APPLICATION
20. First Name
21. Last Name
23. Address
25. City
26. State
27. Zip Code
29. Phone Number
30. Email Address
32. CRITERIA FOR NOMINATION

    Select the category for which the nominee should be considered:

34. Please Select One

    1. performed, created, or developed an activity that positively enhanced or impacted the City of Sunbury
    2. act, achievement, or service that directly or indirectly advanced opportunities or benefited other Sunbury residents
    3. sustained commitment of service over a period of time

36. Please describe in the space provided below or in a written response attached to the application all the following. The applicant may also submit additional supporting materials (i.e. media stories, promotional or educational materials related to the act, activity, or service for which the person is being nominated, etc.): 

38. Describe the act, activity, achievement, or service for which the individual is being nominated
40. Describe the impact of the nominee’s efforts to improve the Sunbury community and/or the number of Sunbury residents positively impacted by the work of the nominee. If a direct impact on residents, include the number of residents positively impacted and generally describe who they are and how they benefited (response optional).
42. Please quantify the amount of effort the nominee put in to achieving the act, activity, achievement, or service to be recognized and over what period of time (response optional).
44. Please include any additional information you think the Committee should consider regarding the work of the nominee and the reason they deserve public recognition (response optional).
46. Supplemental Materials

    These can include media stories, promotional or educational materials related to the act, activity, or service for which the person is being nominated. 

Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit Submit and Print

* indicates a required field