Marty O’Malley Citizenship Award Nomination Form

Nomination Details-The person or group that you would like to nominate

Nominee First Name (or group name) (*Required)

Nominee Last Name (if group enter none) (*Required)

Nominee Email (*Required)

Nominee Phone Number (*Required)

In which field/sector(s) has the nominee made the most significant contributions? Check all that apply. (*Required)
Arts and cultureBusiness and EntrepreneurshipEducation and academiaEmergency servicesEnvironmentalism and conservationFinancial support and servicesGovernment and public serviceHealthcareMental healthMulticultural interestsSports and recreationYouth engagement and developmentOther (please specify below)

Other

Which organization has the nominee been most involved in or contributed the most work to if applicable?

Reason for nomination - How has the nominee made a significant contribution to the local community?
This may include specific examples of volunteer work - including establishing or running community initiatives - charity fundraising, advocacy efforts, or other ways in which the nominee has positively impacted the community. Be sure to highlight any unique or innovative approaches they have taken to address community needs or challenges
Min: 50 words (*Required)

How has the nominee demonstrated active citizenship, leadership on a community issue, and enhancement of community life?
This may include volunteering, community involvement, leadership roles, and any other ways in which the nominee has actively worked towards improving their local community. Please include their inspiring qualities as a role model.
Min: 50 words (*Required)

How has the nominee's contribution been recognized elsewhere if applicable?
If the nominee has received recognition for their contributions elsewhere, please provide details here. This can include any awards they have won, any media coverage they have received, or any public recognition they have been given.

Attachments
Please attach any relevant documents or materials that support this nomination, such as letters of recommendation, news articles, or photos – maximum five pages, minimum font size 10 point.

Nominator-Your Details

Your First Name (*Required)

Your Last Name (*Required)

Your Email (*Required)

Your Phone Number (*Required)

Supporter/Alternate Person - Please include details of someone we can contact to support this nomination.

Supporter First Name (*Required)

Supporter Last Name (*Required)

Supporter Email (*Required)

Supporter Phone Number (*Required)

Do you want to remain anonymous to the nominee? (*Required)
YesNo