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2008 Senior Impact Awards Nomination Form

Don't delay!
Submission deadline is June 16, 2008.
Honorees will be selected during August 2008 by community leaders in each of four awards areas.

Priority Health wants to discover and recognize the ways senior volunteers put their energy and commitment to work for the community. You can contribute to this recognition by telling us about someone you know, someone who deserves to be recognized.

Step 1: Please tell us about the person you are nominating.

About the Nominee
Name of nominee:
Street address:
City:
State:
Zip code:
County:
Age of nominee:
Volunteer organization:


Step 2: Please submit no more than a 500-word narrative on the topics listed below.

  1. Provide a brief overview of the volunteer service performed by this nominee at or after the age of 63 that you consider exceptional and worthy of recognition.
  2. Describe when and how the nominee began their community involvement.
  3. Describe the nominee's impact on the community. Please be as specific as possible by citing volunteer hours, number of people served, etc.
  4. Describe how the nominee's activities have changed lives in his or her community.
500 Word Narrative


Step 3: Please tell us about yourself. We may need to contact you for additional information.

About You
Your name:
Street address:
City:
State:
Zip code:
Phone:
Relationship to nominee:
E-mail address:

Last modified 06/16/08