Community Outreach (Nomination form)

COMMUNITY OUTREACH AWARD

Nominations are closed for 2018.

Once submitted, your form will be automatically sent to the NFPB Awards Committee Chairperson. If needed, a member of the NFPB Awards Committee will contact you for additional details.
Click to read about previous recipients of the COMMUNITY OUTREACH AWARD.
PLEASE NOTE: If you'd like a copy of your completed nomination form, please print it from your browser before clicking "Submit."

NOMINATION FORM FOR "THE COMMUNITY OUTREACH AWARD"

* Indicates required field

Name of Person submitting the Nomination *

First

Last

Email of Person submitting the Nomination *

Phone Number of person submitting the nomination *

Name of Your Station's CEO/GM *

First

Last

CEO/GM Email *

Station's Name or Call Letters *

Nominee Type (check one) *

Individual Station, Volunteer/Friends Group

COMPLETE THE FOLLOWING FIELDS IF NOMINEE IS AN INDIVIDUAL

If nominee is an individual, please provide his/her name *

First

Last

Nominee's Email *

Nominee's Phone Number *

COMPLETE THE FOLLOWING FIELDS IF NOMINEE IS A GROUP

If nominee is a group, please provide the group's title i.e. "Friends of WXYZ" *

If nominee is a station or its Friends/Volunteer Group, what was the title of the outreach project or event? *

GROUP contact person *

First

Last

Phone number for the listed GROUP contact person *

Email of listed GROUP contact person *

Station's Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Describe your nominee's community outreach activities and projects at your public media station and why he/she/they should be considered for the "Community Outreach Award." NOTE: Text box will expand as text is inserted. *

Submit

REMINDER: If you'd like a copy of your completed nomination form, please print it from your browser before clicking "Submit."

SUBMIT ONLINE or direct questions to:
Chair, Dorothy Pacella