76 East Main Street
Hornell, NY 14843
ph: (607)324-0808
fax: (607)324-0808
concernf
The Outstanding Youth Award is an annual award designed to recognize youth up to age 20 who have performed a service to their family, school, church or community that is above and beyond the ordinary. Previous winners include young people who have assisted others in times of crises, and those who have been willing to give of themselves and consider the needs of others.
Winners are selected by a committee of school faculty, area agency representatives and community members after a review process of the nomination forms. To assist the selection committee, please give details and examples of the activities the youth has performed. If the student will be graduating this year, give information about future plans. Upon selection, winners and nominators are notified by mail, and will be invited to the annual banquet. Winners will attend as the agency's guest, where they are presented with a savings bond and a plaque to commemorate the occasion.
Name of Nominee: Age/Birthday:________________
Address: _____________________________________________________________
Name of Parent/Guardian: Telephone Number:___________
Social Security Number:____________________________ (for savings bond)
School: Grade:__________
Name of Nominator: Relationship: ________________
Address:______________________________________________________________
Telephone Number: __________________________
Name of one Reference: ________________________________________________
Address: _____________________________________________________________
Telephone Number: __________________________
Give examples of ways this individual has helped others. _______________________
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Any volunteer, work, or community service performed? Please describe:___________
__________________________________________________________________________________________________________________________________________
List any extra curricular activities, clubs, or organizations nominee belongs to: ______ __________________________________________________________________________________________________________________________________________
Has the nominee received any other awards or distinctions? Please list:___________
_____________________________________________________________________
Please list any other information you feel is important for the selection committee to know about your nominee:________________________________________________
__________________________________________________________________________________________________________________________________________
Future plans:__________________________________________________________
_____________________________________________________________________
Copy this form and email to us
Copyright 2011 Hornell Area Concern for Youth, Inc.. All rights reserved.
76 East Main Street
Hornell, NY 14843
ph: (607)324-0808
fax: (607)324-0808
concernf