Youth Achievement Awards Nomination Form

Award Nominee Criteria

Nominees for this award must meet the following criteria:

· CEO or Regional Director of the agency has authorized (via signature on the nomination form) this child as a nominee from that member agency for this award. Nominees must be currently or formerly in foster care.  Each provider agency is allowed to nominate one child per agency program to receive this award;

· He or she has made extraordinary achievements in the past year by meeting and/or surpassing many of the goals set by the agency, FOR EXAMPLE:

o   He or she has overcome significant challenges.

o   He or she shows concern for others and is kind and courteous in most situations.

o   He or she has made significant academic or career progress in the last year.

o   He or she is involved in a hobby or extra-curricular activity

 Please complete and submit the nomination form below by May 20, 2018.

Question Title

* 1. Name of Nominee:

Question Title

* 2. Age of Nominee:

Question Title

* 3. Name of Nominator:

Question Title

* 4. Nominator Phone Number:

Question Title

* 5. Nominator Email Address:

Question Title

* 6. Nominator Relationship to Nominee:

Question Title

* 7. Name, email address & phone number of person who will accompany youth to event (if different from Nominator):

Question Title

* 8. Agency Name and Address

Question Title

* 9. MARFY YOUTH ACHIEVEMENT AWARD NOMINATION STATEMENT

Please use the space below to explain briefly of how the Award Nominee has made extraordinary achievements in the past year by meeting and/or surpassing goals set by the agency.

NOMINEE QUESTIONS & DESCRIPTION

Please list the youth’s answers to the following questions (these will be on the slide with their name/age, agency’s name):

Question Title

* 10. What has had the greatest impact on your success?

Question Title

* 11. What brief (1-2 sentences) “words of wisdom” or advice would you offer to other youth/students like you?

AUTHORIZED SIGNATURES

Question Title

* 12. Electronic Signature of Nominator & Date

Question Title

* 13. Electronic Signature of CEO or Regional Director & Date

Nomination Deadline is COB on June 4, 2018. 
Questions?  Please contact Rachel Mygatt at manager@marfy.org.

T