Survey

VolunCheers! 2011 - Outstanding Volunteer Nominations DUE March 18

Please complete this NOMINATION FORM, including contact information for your nominee so that Serve Rhode Island can inform him/her and provide information about the event. If you are a member agency of Serve Rhode Island and want to recognize a second volunteer, complete a separate on-line form.

In addition to completing this form, the nomination process also requires the submission of a PHOTO OF THE VOLUNTEER and YOUR AGENCY’S LOGO.

These materials, which will be included in the VolunCheers 2011 program booklet, should be forwarded to Neil Francisco, nfrancisco@ServeRhodeIsland.org.

This NOMINATION form, volunteer PHOTO and your agency LOGO are all due MARCH 18, 2011.

If you have any questions, please call Neil Francisco or Janice Pothier Pac at 401.331.2298.

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1. YOUR contact information:

YOUR contact information: First Name:
Last Name:
Organization:
Address:
City/Town:
State:
ZIP Code:
Email Address:
Phone Number:

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2. NOMINEE Information - your volunteer or volunteer team to be recognized at VolunCheers!

NOMINEE Information - your volunteer or volunteer team to be recognized at VolunCheers! First Name
Last Name
Address:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

3. How often does your nominee volunteer?

How often does your nominee volunteer? Daily

Weekly

Monthly

Occasionally

Other (please specify)

4. How long has this volunteer provided service to your organization? (Type number of years.)

How long has this volunteer provided service to your organization? (Type number of years.) YEARS

5. About how many hours does your nominee volunteer during a typical month?

About how many hours does your nominee volunteer during a typical month? HOURS

6. Please describe your volunteer's work in the space provided (100 words or less):

Please describe your volunteer's work in the space provided (100 words or less):

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7. Please explain why your volunteer deserves special recognition in the space provided (100 words or less):

Please explain why your volunteer deserves special recognition in the space provided (100 words or less):

8. If applicable, please briefly describe your employee volunteer and/or community services program (in 100 words or less):

If applicable, please briefly describe your employee volunteer and/or community services program (in 100 words or less):

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9. Please state the Mission or description of your agency.

Please state the Mission or description of your agency.

10. Ticket reservation. Please indicate the number of tickets your organization wishes to reserve for VolunCheers, April 13, 2011 from 5:00 to 7:00 pm at the Twin River Event Center in Lincoln:

Ticket reservation. Please indicate the number of tickets your organization wishes to reserve for VolunCheers, April 13, 2011 from 5:00 to 7:00 pm at the Twin River Event Center in Lincoln: Number of Tickets @ $25 each:
Tables of Ten @ $225 each:

Further information on purchasing tickets for VolunCheers! 2011 will also be posted on our website, www.ServeRhodeIsland.org.

REMINDER: To complete the nomination process you must submit a photo of your volunteer and your agency logo to Neil Francisco at nfrancisco@ServeRhodeIsland.org by March 18, 2011.

THANK YOU FOR NOMINATING AN OUTSTANDING VOLUNTEER FOR VOLUNCHEERS! 2011.