hhapplication

Hometown Heroes Nomination Application

OFFICIAL NOMINATION FORM - PRINT FORM. Please type or print legibly. Photo copies are accepted. Mail or Drop Off Application by February 15, to: Maumee Chamber of Commerce, 605 Conant St., Maumee OH 43537. Phone: 419-893-5805 with any questions. DO NOT FAX FORM.

NOMINEE:

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Name

_________________________________________________
Address

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City / State / Zip

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Phone

Submitted By:

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Name

_________________________________________________
Address

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City / State / Zip

_________________________________________________
Phone

Nominated for which Award? Circle One. 1) Outstanding Citizen Award, 2) Golden Apple Award, 3) Maumee River Award, 4) Bridge Award

Nominee's Occupation / Profession: ____________________________________________________________________________

Communtiy Service (list volunteer activities. leadership positions, etc. (include dates of service):

_________________________________________________________________________________________________________

How has this person made a positive impact on our community?

_________________________________________________________________________________________________________

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Additional Comments are Welcome. Please attach additional sheets if needed. Be sure to include nominee's name on extra sheets.
If you need assistance filling out this application, call the Maumee Chamber at 419-893-5805 and we can offer suggestions.