Volunteer Center of Story County

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VOLUNTEER IN ACTION NOMINATION FORM

Nominations are due by the THIRD MONDAY OF EACH MONTH for consideration for the following month's award.

Nomination Date *

YYYY

Nominee Name *

Nominator Name *

Include Agency Name if Applicable

Nominator Contact Information *

Phone & Email

If you represent a nominating agency, do you have a signed media release for the nominee? *

Yes

Required

What is your relationship to the volunteer being nominated? *

How do you know this person?

How does the nominee give back to their community? *

Why should the nominee be selected as the VCSC's monthly "Volunteer In Action?" *

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Volunteer in Action nominees may be nominated by anyone in the community. Nominations of volunteers not selected for the month, will be kept on file and reconsidered monthly for up to three months, and then may be nominated again. Selected Volunteers in Action will not be eligible to receive the award for two years from when they were selected.

Nominations will be accepted through this form or may be submitted by mail to 130 S. Sheldon Avenue, Suite 201, Ames, IA 50014; email at volunteer@vcstory.org or fax (515) 268-5330.

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