This survey is to be completed by representatives of community service organizations, teachers or youth leaders. 

* 1. Nominee's Name:

* 2. Nominee's Date of Birth (MM, DD, YYYY):

* 3. School nominee is currently enrolled:

* 4. Nominee's Grade:

* 5. Nominee's Email:

* 6. Nominee's Home Mailing Address (Street Address, City, State):

* 7. Nominee's Phone:

* 8. Parent or Guardian's name:

* 9. Nominee Guardian/Parent's Phone

* 10. Nominee Guardian/Parent's Email:

* 11. Please submit a 150-200 word essay that describes the act of courage, compassion or leadership the nominee demonstrated that showed a commitment to ensuring equal rights and compassion for others.  Please be specific and describe any obstacles they may have faced during the course of their service.

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* 12. List approximate number of volunteer hours served.

* 13. List the organizations the nominee is involved with and contact names if available.

* 14. I certify that I am not a reletative of the nominee nor an employee at International Paper.

* 15. Please provide your name:

* 16. Your email:

* 17. Organization or affiliation: