Newell B. Sargent Spirit of Philanthropy Nomination Form
Exit this survey
1. Default Section
*
1
. Nominee Contact Information
Nominee Contact Information
Nominee Name:
Profession or Position
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Country:
Email Address:
Phone Number:
*
2
. Your Information
Your Information
Your Name:
Your Organization:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Country:
Email Address:
Phone Number:
After reviewing the criteria in the attached announcement, please answer the following questions as completely as you can. Please limit your narrative to 500 words.
3
. How has your nominee created or promoted benevolent projects or ideas within your organization, within your community or within Wyoming?
How has your nominee created or promoted benevolent projects or ideas within your organization, within your community or within Wyoming?
4
. Give examples of how your nominee has been extraordinarily generous with their wisdom, wealth and work. While you may be as specific as you wish, we do not seek to know actual amounts of monetary gifts.
Give examples of how your nominee has been extraordinarily generous with their wisdom, wealth and work. While you may be as specific as you wish, we do not seek to know actual amounts of monetary gifts.
5
. Anything else you wish to tell us about your nominee?
Anything else you wish to tell us about your nominee?
Nominations for 2010 must be submitted on or before April 15, 2010. The 2010 Newell B. Sargent Spirit of Philanthropy Award will be awarded at Wyoming Philanthropy Days in Laramie on June 17th.
Powered by
SurveyMonkey
Create your own
free online survey
now!
Javascript is required for this site to function, please enable.