Youth Civic Award Nominations
Youth Civic Engagement Nomination Form
Your Name
*
Your Phone Number
*
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)
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Your Email
*
Relationship to Nominee
*
Nominee Name
*
Nominee Phone Number
*
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)
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Nominee Email
*
Nominee Mailing Address
*
Street 1
Street 2
City
State
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AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
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MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
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SC
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TN
TX
UT
VT
VA
WA
WV
WI
WY
AA
AE
AP
FM
GU
MH
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PR
VI
AS
Zip
Description of Outstanding Community Service
*
Parent/Guardian Names
*
Parent/Guardian Phone Number
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)
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Parent/Guardian Email