Each month, a community champion will be selected based on a nomination for their outstanding work in their community. Nominees can include, but not limited to; teachers, community leaders, youth coaches, volunteers, and public servants. Register a nominee below and Show UCare!

Please fill out the following form!

NOMINEE INFORMATION
Nominee First Name:

Nominee Last Name:

Nominee Email Address:

Nominee Address:

Nominee City:

Nominee State:

Nominee Zip Code:

Nominee Home Phone Number:

Nominee Work Phone Number:


NOMINATOR INFORMATION
Nominator First Name:

Nominator Last Name:

Nominator Email Address:

Nominator Address:

Nominator City:

Nominator State:

Nominator Zip Code:

Nominator Home Phone Number:

Nominator Work Phone Number:


Personal Actions:
Using the space below, describe the nominee's personal actions that they have taken to go above and beyond in their community.

Community Impact:
Beside the outstanding acts of the nominee, this individual has positively impacted the community. Describe the acts that this nominee is/was responsible for and how they affected their community (300 - 500 words).

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