Junior Citizen of the Year – Nomination Form

Use the form below to submit a nominee. WE ENCOURAGE AS MUCH INFORMATION AS POSSIBLE. All nomination forms will be held in strict confidence and will only be provided to the selection committee.

You can also download the paper version of the 2021 Junior Citizen of the Year nomination form here.

    Name of Nominee

    Date of birth (mm/dd/yyyy) (Cannot be older than 18 as of May 31, 2021)

    Address (Mailing Address)

    City/Town

    Postal Code

    Telephone Number

    Nominee's Parent or Guardian

    Parent or Guardian's Phone Number

    Name of Nominator

    Address (Mailing Address)

    City/Town

    Postal Code

    Telephone Number

    Relationship with Nominee

    Name of Nominee's School

    Nominator's Local Newspaper

    State your reasons for nominating this person.

    Please describe the extraordinary circumstances (physical, emotional or environmental) that make this nominee's accomplishments significant.

    Describe how this nominee has influenced others and why the efforts succeeded.

    Describe how this nominee supports and helps at home.

    Describe how this nominee's attitude toward life supports the nomination.

    Add further comments or additional supporting materials you feel are important.