2008 Jefferson Awards Nomination Form
Rachel Mitchell
Jefferson Awards Coordinator			All information is required for security purposes only. The American Institute for Public Service will not contact the nominee or nominator until given permission by the Media Sponsor's Jefferson Awards Coordinator.
(662) 842-7620______________________
Direct Contact Number
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Full Name of Individual Nominated			Name of Nominator
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Street Adress			Street Adress
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City	State	Zip	City	State	Zip
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Daytime Phone Number	Evening Phone Number		Daytime Phone Number		Evening Phone Number
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Date of Birth
The following sentence needs to be completed. This should be a powerful statement. It is the first sentence the Board of Selectors reads about your nominee. It sets the tone for the rest of the biography.
This individual is nominated for a 2008 Jefferson Award because . . .
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Please use the following questions to help assist you while writing the biography that will be submitted to the Board Selectors for concideration in representing you at the National Ceremonies in Washington, DC.
1. How has this nominee impacted the community?
2. How many years has this nominee given of his or her time and resources to help the community? (Please include all the years the person has helped the community even if their nomination focuses on a specific project).
3. What makes this individual deserving of the Jefferson Award?
4. Is this service ~ volunteered or a paid position?