Good Neighbor of the Year Awards

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April 01, 2016
                                         

Scottsburg Mayor’s
Good Neighbor of the Year
Nomination Form
 
Deliver to Scottsburg City Hall or mail to:
 
Scottsburg Beautification Committee, Inc.
Mayor’s Good Neighbor Award
2 East McClain Ave.
Scottsburg, IN 47170-1893
 
I would like to nominate the following as the 2016 Good Neighbor of the Year:
 
Name:_________________________________________________________            
 
Address:_____________________________________________________
       
Phone #:____________________ Email:______________________________  
   Please check one category only:
 
                   Business/Industry
                   Church/School/Civic/Other (Youth group- Age 18 & Under)
                   Church/School/Civic/Other (Adult group- Age Over 18)
                   Individual (Youth-Age 18 & Under)
                   Individual (Adult-Age Over 18)             _____ Nominee Jacket Size
 
Please list accomplishments & activities from 2015-2016 that should be considered on a separate sheet of paper or complete the information on the back of this sheet. Please describe in as much detail as possible. In fairness to the nominee completed information MUST be submitted for the nomination to be considered and accepted.  All nominations are subject to review by the Committee.  Past recipients of the Individual Good Neighbor Award are not considered for re-nomination.
 
Nominator  Name: ___________________________ Phone #:_________________                                 
Address:__________________________ Email:___________________
(Must be filled out for nomination to be accepted)
Deadline for Nominations:   May 6, 2016
 
NOMINEE INFORMATION
 
Please tell us why you would like to nominate this person?
 
 
 
 
 
 
 
 
Accomplishments:
 
 
 
 
 
 
 
 
 
 
 
 
Activities:
 
 
 
 
 
 
 
 
 
 
 
(Attach additional sheets if necessary)