Civic Cup Nomination Form

Qualifications for the Lafayette Civic Cup:

The individual must have accomplished an outstanding humanitarian and/or civic deed for the benefit of the Lafayette Community and/or Individuals.
The individual must not have received remuneration for said work.
The individual’s deed must not have been done in the regular line of duty. One of the most vital requirements is that the civic work(s) for which an individual is nominated is in no way connected with the individual’s vocation or profession.
No person holding an elected office of political nature will be eligible to receive the award.
Organizations are not eligible to receive the award. The Lafayette Civic Cup Award is a service award for an outstanding Lafayette Individual.

Nominations are due by 11:59 p.m. on Friday, Sept. 30

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* 1. Nominee Information

Nominee Name:

Nominee Organization or Company, if any:

Nominee Phone Number:

Nominee Address:

Nominee Email Address:

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* 2. Your Information

Your Name:

Your Organization or Company, if any:

Your Phone Number:

Your Email:

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* 3. Please explain why you are nominating this individual for the Civic Cup.

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* 4. Please list ways the individuals deeds have resulted in civic improvement and community betterment.

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* 5. Please list organizations or groups in which he/she is involved, including fraternal and religious organizations, and offices held.

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* 6. Please list any other accomplishments and/or community service not covered above. (Optional)

* All nominees will be considered and a nomination does not imply, suggest or guarantee that the nominee will be selected. Nominee’s names may be submitted by individuals or organizations. Individuals, clubs, or organizations may submit more than one nomination. Nominations must be submitted by 11:59 p.m. on Friday, Sept. 30, 2016. The winner of the Lafayette Civic Cup Award will be determined by a vote of the Judges Committee.