Dr. Martin Luther King, Jr. Commemorative Program
Community Involvement Recognition Awards
NOMINATION FORM

 

Nominator Information (Your information)
Name
Address
Telephone
Email
Award Nominee Contact Information
Award Type
Name of Nominee
Telephone
Address
Email
Nominee's Affiliation


Please specify name of school, organization, agency, etc.

 

Please briefly explain the nominee's involvement and contributions to building community in one or more of the following way:

  • Promoting nonviolence
  • Combining religious beliefs with positive social action
  • Working toward racial equality and harmony
  • Advocating for/working with disenfranchised people
  • Advancement of educational opportunities in West Philadelphia

Please be as specific as possible about the extent of the nominee's contributions, including, if possible, the number of years of involvement, the people/groups who have been positively influenced by the nominee's work, etc.
Please list other honors, awards or recognition the nominee has received:
Please also include a brief biography, resume or curriculum vitae for the nominee:

Please share with us the names of two other people familiar with the nominee's work:

Reference 1
Name
Address
Telephone
Reference 2
Name
Address
Telephone

 

 

 
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