Senior of the Year 2017 Nominee Form!

SENIOR OF THE YEAR NOMINATION FORM 2017

Submissions must be made by Friday, March 3, 2017. The information that you provide will be incorporated into the Ceremony in May as well as a picture of the nominee. Please fill out this form. Any questions please email Sherrie Gilmore at sherrie.gilmore@putnamcountyny.gov

Senior of the year Nominee First & Last Name*
First Last
Nominee Nick Name (if any)
Nick Name
Nominee Address*
Street Address Address Line 2 City State ZIP Code
Nominee Phone Number*
Email*
Organizations of which the nominee volunteers/has volunteered
Years in Volunteer Service*
Previous or Current Profession*
Military Branch
- Army
- Marine Corps
- Navy
- Air Force
- Coast Guard
Number of Children
Number of Grand Children
Number of Great Grand Children
Biography of the Nominee*
Brief Biography of the nominee (i.e., are they a native New Yorker, how long have they lived in New York, where they currently reside, past/present career, family details: (Approximately 100 words)
How the Nominee Made a Difference*
Details about how the nominee has made a difference in your community through civic engagement: (Approximately 125 words)
What advice does the nominee have about volunteering for other New Yorkers?*
What advice does the nominee have about volunteering for other New Yorkers? (Approximately 50 words)