2012 COMMUNITY AWARD NOMINATION FORM
Please print all information. Thank you
Date of request: ________________________
Requestors Name: ___________________________________________________________________
Requestors address:_________________________________________________________________
___________________________________________________________________
Requestors phone: Home ____________________________ Work _______________________
ORGANIZATION INFORMATION
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Name of organization: _________________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Phone number: _______________________________________________________________________
Email address: _______________________________________________________________________
Name or CEO, COO or president: (Include their contact information if different from above)
_____________________________________________________________________________________
Services provided by the organization: ___________________________________________________
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Tell us why you believe that this organization should receive our support.
Submit application to: Application deadline March 31, 2011
Lynn Morgenstern
7801 W. Caldwell Ct.
Milwaukee, WI 53218
lemorgenstern60@yahoo.com