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* 1. 1. Name of Employee

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* 2. Nominated By & Contact Information

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* 3. Employee’s Immediate Supervisor

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* 4. Date of Service

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* 5. Describe the service activity/event.

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* 6. How was the employee involved?

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* 7. What, if any, obstacles did this nominee overcome to deliver this service to the community?

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* 8. How does this exhibit our core value of We Build Community?

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