Basin Wide Foundation Award Nomination Form

Categories:

Together We Can (person or organization(s) that best display the BWF motto of Together We Can);
Lifetime Achievement; Basin Wide Cultural Contributor; Volunteer; Youth Volunteer

Today’s Date:                                                  Category_____________________________

 NOMINEE:    NAME:                                                                                                                                   

                         TITLE OR POSITION:                                                                                                    

                         COMPANY/ORGANIZATION:                                                                                           

                         ADDRESS:                                                                                                                             

                        CITY:                                                                                                                                      

                        WORK PHONE:                                              HOME                                                

NOMINATOR: Signature of Nominator:                                                                                                            

Printed Name of Nominator:                                                                                                                                    

COMPANY/ ORGANIZATION of Nominator:                                                                                        

PHONE of Nominator:                                                                

Please use the following as a guide for your nomination: If additional space is needed add another sheet of paper.

REASON FOR NOMINATION: (List special recognition’s, projects, achievements, affiliations and activities)

                                                                                                                                                            ______

COMMUNITY SERVICE: (Describe local, county, and state level participation, length of service and offices held
in civic and service organizations, charitable activities, political pursuits, religious groups, etc.)

OTHER MEMBERSHIPS, ACHIEVEMENTS, AWARDS, PUBLICATIONS: (Nominee may already have
been honored for service to their profession, industry or community.  They also may have publications to their
credit or articles published supporting their service to their publication, industry or community.
Please list awards and honors received, which support this nomination)