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2011 Clarence H. Moore Award
 
     
 

The 2011 Clarence H. Moore Award for Excellence for Voluntary Service Nomination Form

Before completing this nomination form, please be sure that you have read and understand the award guidelines. Please ensure you complete all the required fields in your application.

Instructions: Please fill in all the requested information on the nomination form and attach a letter of nomination (two-page limit) signed by the nominator, letter of support (two-page limit), and the annual report. Unfortunately, we are unable to consider unsigned documents.

To be considered, please ensure that you have completed and submitted the online nomination on or before the closing date of the call.

All items marked with an asterisk (*) must be completed.

Note: You must click the “Save” button at the bottom of each page to save your responses.

If you have questions about completing this form, contact 		 
  STEP 1 of 4  
  Nominated Organization Information
  Organization’s name *
  Address *
  City *
  State or province *
  Country *
  Telephone number *
  E-mail address *
  Website
  Number of paid staff *
 
Ratio of volunteer staff to paid staff *
  Year established *
  Type of organization *
 
Annual budget (estimated in US$) *
  Selected Honors and Awards
  (Please list in reverse chronological order)
  * 1.
  2.
  3.
  4.
  Financial Support
  List specific sources of financial support and their percentage
of the annual budget
  * 1.
  2.
  3.
  4.
     
 
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