Hornell Area Concern for Youth

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.  _______________________

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Any volunteer, work, or community service performed?  Please describe:___________

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List any extra curricular activities,  clubs,  or organizations nominee belongs to: ______ __________________________________________________________________________________________________________________________________________

Has the nominee received any other awards or distinctions?  Please list:___________

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Please list any other information you feel is important for the selection committee to know about your nominee:________________________________________________

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Future plans:__________________________________________________________

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