Profiles of Success Awards Nomination Form

Nomination Instructions:
Complete the nomination form and use the submit button or mail to the address noted below. Please allow yourself enough time to complete the entire nomination form. It is recommended that you prepare your nomination off-line, and copy/paste your answers in the space provided.

Nominations and supporting material must be received by 5 p.m. Friday, Apr. 16, 2010. There will be no exceptions to these procedures.

* required fields

Eligibility

Name of Nominee:* 

Company/Organization:* 

Address:* 

City:*  State:*  Zip:* 

Daytime phone:*  (include area code)

Mobile phone:  (include area code)

E-Mail address:* 

Is nominee aware of nomination?* Yes No (Please mark one)

AWARDS CATEGORIES & DESCRIPTIONS (Please mark one)*

The Award Selection Committee may choose to add a new or different category based a particular individual’s contributions. Past award recipients may be re-submitted for consideration in other categories.

HALL OF FAME —This award is given in recognition of life-long dedication to Latino issues through efforts that have significantly impacted the lives of many in a positive way and beyond expectations. This candidate’s contributions should be of general knowledge to the community in which he/she lives.

EXEMPLARY LEADERSHIP —This award is given to those who have contributed a number of consistent years toward Hispanic issues, giving their personal time and making a significant difference to the communities they serve.

LORRAINE LEE LATINO ADVOCACY CHAMPION —This award gives special recognition to an individual who has been an ardent advocate on Latino issues.

RAÚL YZAGUIRRE COMMUNITY LEADERSHIP —This award gives special recognition to an individual for his/her significant philanthropic contributions, support for a nonprofit organization, and community development.

SPECIAL RECOGNITION —This award spotlights individuals who have taken a dramatic and/or courageous stand on an issue affecting Hispanics or who have contributed to positive outcomes of Hispanic causes.

MANUEL ORTEGA YOUTH LEADERSHIP —This award was created to encourage young leaders, ages 16-25, who are discovering their leadership skills and passions and who are putting their leadership abilities to work. (Nominee must be in good academic standing, if applicable. Please mail a copy of his/her transcript. )

1. Give a brief overview of the leadership activities of the nominee through his/her organization(s) or service(s). Be sure to include the names of the organizations in which the nominee has acted in a leadership role. In giving this description for the Manuel Ortega Youth Leadership Award, be sure to include how the nominee goes beyond school and family life in a leadership role. (Type or copy/paste in the area below or mail in. If mailing in, please note in the text box.)*

2. Describe how long the nominee has demonstrated leadership, i.e., how much personal time, each week or month, does the nominee give to volunteer activities; or, how long has the nominee focused on a particular issue or initiative. (Type or copy/paste in the area below or mail in. If mailing in, please note in the text box.):*

3. Describe any special challenges (physical, financial, time, etc.) the nominee has had to overcome to perform as a leader. How has this nominee served as a role model? (Type or copy/paste in the area below or mail in. If mailing in, please note in the text box.)*

4. Describe one example of the nominee’s creativity in meeting leadership challenges. (Type or copy/paste in the area below or mail in. If mailing in, please note in the text box.)*

5. List any special positions, offices, accomplishments or recognition the nominee has received or earned. Include approximate dates. (Type or copy/paste in the area below or mail in. If mailing in, please note in the text box.)*

6. What has been the impact of the nominee’s efforts and who has benefited by these efforts? (Type or copy/paste in the area below or mail in. If mailing in, please note in the text box.)*

Nominator Information

Name of nominator:* 

Relationship to Nominee:* 

Company/Organization: 

Address:* 

City:*  State:*  Zip:* 

Daytime phone:*  (include area code)

Mobile phone:  (include area code)

E-Mail address:* 

How did you learn about these awards?

Will you be sending supporting documentation?*
Limited to 5 pages of background information, which may include newspaper/magazine clippings or other documents that support, not restate, your nominations. Scrapbooks or videotapes are not permissible; return of photos and documents is not guaranteed.
Yes No (Please mark one)