EMAIL COMPLETED FORM TO: [email protected] HARD COPY MAY BE FAXED: 248-852-6764, MAILED: 1435 W Auburn Road, Rochester Hills, MI 48309 OR SENT VIA AVONDALE INTERSCHOOL MAIL

NOMINATION FORM YOUTH RECOGNITION AWARDS Sponsored by Avondale Youth Assistance and the Auburn Hills Morning Optimist Club Who is eligible to receive Recognition? Any student in grade 5 or higher who attends public, private or parochial school within the Avondale School District or resides within the Avondale School District. NOMINEE’S NAME:

GENDER: Male

ADDRESS:

CITY/ZIP:

SCHOOL:

GRADE:

PARENT/GUARDIAN’S NAME:

PHONE:

Female

**************************************************************************************************** NOMINATOR’S NAME AND ORGANIZATION: AFFILIATION OR TITLE: ADDRESS:

CITY/ZIP:

PHONE:

Please check type of award for which youngster is being nominated: Community Service Award - To recognize youth who: 1. Perform personal acts of heroism 2. Perform outstanding non-reimbursed (volunteer) service to the community, i.e., After-school tutoring, volunteering in nursing homes, hospitals, churches or taking part in community activities such as beautification projects. Volunteering should be performed for a duration of time, although special exceptions will be considered. Extracurricular activities such as band, athletics, etc., are not eligible. Academic achievement is also not eligible unless circumstances conform to the Personal Achievement Award guidelines (below). Personal Achievement Award - For youth that have demonstrated a dramatic positive change in attitude or behavior, overcome a significant obstacle (health, family situation, etc.), or have made a strong, positive academic turnaround. To be considered for an award you must Be As Detailed As You Can When Describing Why You Are Nominating This Young Person: Please write a paragraph that would be suitable for publication in some of our local newspapers. Please provide the following: What organization has the young person been involved with? If volunteer service, when did this take place and for how long? What was the impact of this activity on others? If you are aware of other worthwhile activities this young person has been involved in, possibly in a different setting, please include. Please enter your description on the next page. Go to Page 2 Page 1

Description:

PLEASE SUBMIT FORM(S) BY EMAIL, MAIL, FAX OR AVONDALE INTERSCHOOL MAIL. AVONDALE YOUTH ASSISTANCE 1435 W AUBURN ROAD ROCHESTER HILLS, MI 48309 FAX: 248-852-6764 EMAIL: [email protected]

PLEASE CONTACT THE AVONDALE YOUTH ASSISTANCE OFFICE AT 248-852-3716 SHOULD YOU HAVE ANY QUESTIONS.

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