November 7, 2017August 12, 2020 admin Please submit all nominations no later than our listed date. Candidates must be age 60 or older. A mailing address is required for each nominee. Please also provide an e-mail address if available. Please enable JavaScript in your browser to complete this form.Nominee Title *Mr.Mrs.Ms.Dr.OtherIf other, please specify First Name *Last Name *Company/OrganizationAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *How has the nominee contributed toward improving the lives of seniors and/or people with disabilities in Genesee, Lapeer, or Shiawassee County? Consider the following: How has this nominee’s volunteerism gone beyond expectations? How long has the nominee been volunteering? Who benefits from the contributions made by the nominee and how has it changed their lives? How does the volunteer help give seniors and those with disabilities more independence?Please summarize the nominee’s impact on seniors and the disabled in our community.Nominator Title *Mr.Mrs.Ms.Dr.OtherIf other, please specifyFirst Name *Last Name *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *May we share your name with the nominee? *YesNo, thank you. I'd rather my nomination remain anonymous.NameSubmit40304
