2023 Community Service Nomination Form

Please complete this form for each business category on behalf of a deserving organization in Lake County Florida for the 2023 Community Service Awards banquet.

Review the list of the previous award winners as recipients can only win one time in each category.

Question Title

* 1. Under what category does the nominated organization qualify?

Arts/Cultural

Leadership

Humanitarian

Volunteer

Healthcare Provider

Hall of Fame Business Award

Public Service

Chris Daniels Public Safety

Non-Profit Organization

Education

Sports/Athletics

Entrepreneur

Youth Award

Small Business Achievement Award (1-11 employees)

Medium Business Achievement Award (12-39 employees)

Large Business Achievement Awart (40+ employees)

Question Title

* 2. Please provide the following information about the organization.

Name

Business/Profession/Association

Address

Phone

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* 3. Other awards or recognition received by nominee related to the qualifying category.

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* 4. Club, Organization, & Positions related to the qualifying category.

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* 5. To complete the application, attach a supported file providing the reasons for nomination to help differently the nominee and highlight their achievements. (No more than 500 words)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 6. Please provide your contact information below.

Name

Company

Address

City/Town

State/Province

Email Address

Phone Number