Niagara Foundation :: Nomination Form

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Nomination Form
Niagara Peace & Dialogue Awards
Thursday - June 4, 2009

All individuals/groups who have contributed their time, energy, leadership, and dedication to the cause of dialog, peace, education, community service, tolerance and understanding are eligible for nomination.

• Significant effort promoting mutual understanding, peace and dialog among different communities.

• Outstanding action in cooperation and service with individuals or groups of varying societies.

• Significant contribution of time and resources.

Nominee Information:

Name:

Occupation:

Organization:

Telephone:

Fax:

E-Mail:

Address:

Please select the catagory in which you want your nominee to be awarded:

Peace Award

Diversity Award

Community Service Award

Education Award

Tolerance Award

Media Award

Fethullah Gulen Leadership Award

Government Award

Environment Award

Please share your suggested category with us:

Questions to be answered by the committee for each nominee:

1) Describe the volunteer/community efforts performed by the nominee, and the impact on the community.

2) List examples of work, service, and number of people impacted, etc.

3) Describe who or what type of group (homeless, children/youth, unemployed, etc.) has benefited from the nominee's service.

4) Is there anything else the Awards Committee should know about this nominee?

Nominator Information:

Name:
Telephone:
Fax:
E-Mail:
Address:

Downtown Office: Corner of Michigan & Lake

Niagara Foundation
205 N. Michigan Ave. Suite 2540
Chicago, Illinois 60601

Tel: (312) 240 0707
Fax: (312) 240 0706

Email: info@niagarafoundation.org