Given annually to honor significant contributions to diverse populations and communities.

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* 1. Nominee name:

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* 2. Nominee address:

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* 3. City:

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* 4. State:

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* 5. Zip:

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* 6. Phone:

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* 7. Email address:

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* 8. Nominator's name:

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* 9. Nominator's phone:

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* 10. Nominator's email address:

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* 11. Date submitted:

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* 12. Describe how this individual has contributed to a diverse population or community through the sport of tennis over the past year by listing and describing their activities:

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* 13. Where does this person teach, coach or volunteer?

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* 14. Please list specific programs or events this person initiated or was involved in with a multicultural community:

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* 15. How does this individual reach out to diverse communities and work with them to bring tennis opportunities to their area?

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* 16. Please share any additional information about this individual in support of this nomination:

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