Volunteer of the Month Form

You may fill out the form below to submit a nominee for Volunteer of the Month or download the Volunteer of the Month Nomination Form (PDF) and fax it to 606-677-6055.

Name *

First

Last *

Last

Mailing address: *

Phone number *

Organization where volunteer service was performed (and position, if applicable):

(Paid employees are not eligible for consideration unless service is well above and beyond the description of their regular duties.)

Description of nominated service: *

(Describe in detail the service you feel is noteworthy)

Period of service: *

(Need not be limited to month nominated.)

Volunteer hours:

(If recorded)

Related or other volunteer service:

(List actions or endeavors that show a pattern of volunteerism. This program recognizes individuals who routinely "give back" to their communities.)

Other pertinent information:

(Any other information you feel strengthens your nomination and introduces your nominee.)

Place of work and job title (if applicable):

Name *

First

Last *

Last

Title

Organization:

Email address *

Phone number

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Eastern Kentucky PRIDE