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* 1. Name of individual being nominated

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* 2. Please list the nominee's organization affiliation (if applicable)

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* 3. Nominee’s street address

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* 4. Nominee’s city

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* 5. Nominee’s state

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* 6. Nominee’s zip code

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* 7. Nominee’s phone number

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* 8. Nominee’s email address

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* 9. Nominee’s website address (if applicable)

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* 10. Name of Nominator

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* 11. Nominator's phone number

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* 12. Nominator's email address

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* 13. List association (if any) of nominator with nominee

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* 14. In 1,000 words or less, explain why your nominee is best qualified to receive the award and how they are impacting nonprofit organizations, churches, schools, and Jefferson Parish.

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* 15. Please attach additional pages and/or information if it adds to the nomination. (Optional)

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