Dr. Martin Luther King Jr. Birthday Celebration Committee of Nassau County, Inc.

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Nominate Awardees

Dr. MLK Recognition Award - Nomination Form

NOTE: A photograph of the nominee (suitable for publishing in the Commemorative Journal, should the nominee be selected) and two (2) letters of recommendation are required. These items may be sent via
e-Mail: rmcrae@nassaucountyny.gov Or, by mail to:

Dr. MLK B'day Celebration Committee of Nassau County, Inc.
240 Old Country Road (Room 601), Mineola NY 11501.

Nominations for the 2012 Awards must be received by October 31, 2011.

Nominee 1st Name:
Nominee Surname:
Middle Initial:
Title:
Organization:
Phone:
Fax:
e-Mail:
Choose a field in which Nominee has "built bridges"
		Civil Rights
		Education
		Employment or Economic Development
		Humanitarianism
Describe, in general, why Nominee deserves this award (30 words or less)
What need is addressed by Nominee's work, activity or achievement?:
Why is Nominee's work, activity or achievement important?:
Who is serviced by Nominee's work, activity or achievement?:
How does Nominee impact the local or greater community?:
Is Nominee's work, activity or achievement paid or voluntary?:
If paid, what aspects of Nominee's work, activity or achievement are beyond the "call of duty"?:
How does Nominee's work, activity or achievement exemplify the goals of Dr. Martin Luther. King, Jr?:
Nominator's Full Name:
Nominator's Title:
Organization:
Phone:
Fax:
e-Mail:
Relationship to Nominee:
Today's Date:

Thank you for your interest in the 2012 Dr. Martin Luther King Jr. Birthday Celebration Committee of Nassau County, Inc. Your Nomination form information will be reviewed. Someone will respond to your query from this committee following submission of completed data form above. Kindly, submit your information below as the recommender of the above nominee.

If you have any questions, please feel free to call Mr. Rodney H. McRae at 516-571-5977. Thank you.

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
Comments:	Enter comments here!