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NOMINATION FORM
PUBLIC SERVICE AWARDS

UNITY PAC

Annual Awards Nomination Form

Recognition awards in each of the below categories will be given at the annual banquet scheduled for September 13, 2009. The deadline for submission of awards is the last Friday of July of each year.  Award recipients will be recognized during the Awards Banquet.  If you would like to submit a nominee for an award please complete this form and submit it to us prior to the deadline.  Note: Attachments must be in PDF or Word format to be accepted electronically.

Please fill in the following information and then click the "Submit" button to make your nomination.

Note: A pointing hand indicates that a response is required.

Nomination Information

AWARD TITLES AND DESCRIPTIONS

Select one of the following categories for which you wish to nominate the nominee to receive an award

ELBERT WALTON - LIFETIME ACHIEVEMENT AWARD
Has a record of exemplary and outstanding achievements in his/her profession, community and/or among his family, friends or peers

OUTSTANDING CITIZENSHIP AWARD
Has been a model citizen in politics, public, civic or community service

COMMUNITY AWARENESS AWARD
Has been a leader in managing, directing and/or promoting outreach programs, organizing the community, and educating the public on issues of public importance

JOSEPH WASHINGTON - UNCOMMON VALOR & PUBLIC SAFETY AWARD
Has performed an act of valor, self sacrifice or exemplary service in promoting public safety

OUTSTANDING ROLE MODEL AWARD
Have qualities and characteristics exemplary and outstanding in nature to which our youth should model their lives

OUTSTANDING ENTREPRENEUR AWARD
Has been successful as an entrepreneur and has given back to the community in terms of financial contributions as well as community service

OUTSTANDING MEMBER AWARD
Member of Unity PAC who has provided the most outstanding service to the organization over the past year

OUTSTANDING ELECTED OFFICIAL AWARD
Given to a publicly elected official who has provided outstanding service to his constituents over the past year

OUTSTANDING MINISTER AWARD
Given to a religious leader who has provided exemplary service to the community

OUTSTANDING YOUNG ACHIEVER AWARD
Given to a person under the age of twenty-three who has been outstanding in academic, athletic or community achievements
 

Name of Nominee  
Title:  
Organization:  
Employer/School:  
Address:  
City:  
State:  
Zip:  
Phone:  
Fax:  
Email:  
Give a detailed statement in support of Nominee:  

You may e-mail a more detailed statement and any resume or curriculum vita available in support of the nominee in PDF or Word format:

Click here to e-mail additional details to the Awards Chairperson

 

Nominator Information

Please note: Members of the public as well as members of Unity PAC are invited to submit nominations..

Name of Person Making Nomination:  
(if different from above)
Title:  
Address:  
City:  
State:  
Zip:  
Phone:  
Fax:  
Email:  
Date submitted  
MAKE SURE YOU HAVE FILLED IN THE FORM COMPLETELY
BEFORE CLICKING THE SUBMIT BUTTON

Upon completion of form click this button 

 

Links

Order Awards Dinner Tickets
Order Ad for Souvenir Booklet
Banquet Home Page


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