CCCF Leadership Awards

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Nominee’s Name*
Nominee's Address
Street Address City State / Province / Region ZIP / Postal Code
Nominee's Email
Nominee's Phone Number*
Nominee Type (select only one)
- Individual
- Business
- Organization
Your Name (Nominator)
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Email*
How did you hear about the awards program?
(i.e., postcard, website, newspaper article, friend)
Please share with us how you know the nominee.
QUESTION #1*
1. What is the geographic area impacted by the nominee’s work? Please reference the specific community and wider reach (county-wide, region-wide, state-wide, nation-wide) when appropriate.
QUESTION #2*
2. What did the nominee do to make a difference? Please reference the award category and provide three examples.
QUESTION #3*
3. What characteristics make the nominee an outstanding leader?
You may also attach a resume for the nominee or related newspaper articles or other materials.
Max. file size: 20 MB.
Acknowledgment of Deadline*
- I understand the deadline for receipt of application is March 10, 2023
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