Nomination Form

Do you know an individual or organization that has made an extraordinary contribution to
enrich the lives of children in the Sac-Sierra Region?

KidsFirst (formerly the Child Abuse Prevention Council Placer) will recognize Kids, Teens, Grown-Ups and Teams who contribute their time, talent or treasure to help KidsFirst achieve its vision that all children live in a safe, healthy and nurturing home.
Please submit your nomination below.

Nominations due February 19, 2010.
 

Please nominate someone best described in one of these categories:

Piggy Bank Contributor
This award is presented to an organization or individual with a proven record of exceptional generosity.  A proven record includes direct financial support or leadership demonstrating outstanding civic and charitable endeavors, including philanthropic leadership that encourages others to support the prevention of child abuse.

Volunteer (Kid, Teen, Grown-up and Team)
The following awards are presented to volunteer(s) whose activities go beyond the scope of their normal work responsibilities and further KidsFirst's vision that all children live in a safe, healthy and nurturing home.

Examples: The nominee impacts children and families through change or leads by example. A significant amount of time is devoted to activities or services that enrich the lives of children. The nominee contributes a needed service to children and families. The nominee initiates new programs or activities to help keep kids and families safe.

Nominee Information
First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Phone # *
E-mail Address
Age
Parent's Name
*Parent name only required if nominee is under 18.
Daytime Phone Number

**Nominees (or their parents) will be contacted by Nomination Co-Chairs Autumn Heacox or Jackie Howard, or KidsFirst staff for further information.
***E-mail and phone numbers for nominees under the age of 18 should be the parent's contact information.

Please provide the following information:
Please Select a Nomination Category: *

1. A brief description of the nominee's activities beyond normal responsibilities

that contribute to KidsFirst's vision that all children live in a safe, healthy and nurturing home.
*

2. Any additional information about the nominee (e.g. memberships, philanthropic

affiliations, recognitions, awards received, overcoming significant challenges, etc.)
*

3. Provide two references and contact information (i.e. name, address,

daytime phone number, email and relationship to the nominee.)
*

 

Nominator Information
First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Phone # *
E-mail Address
Relationship to nominee *
How did you hear about the KidsFirst Awards Luncheon call for nominations?

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Questions?

Please contact Nominations Committee Co-Chairs
Autumn Heacox ~ AutumnHeacox@gmail.com ~ 916/439-6054
Jackie Marie Howard ~ jackiemarie@pacbell.net ~ 916/773-7373