The Tribune

Nominator Name:

Nominator Business:

Nominator Business Address:

Nominator Email:

Nominee Name:

Nominee Email:

Nominee Phone:

Nominee Business:

Nominee Mailing Address:

Nominee Date of Birth (dd/mm/yyyy):

How long has the nominee lived and worked in the county?:

Please describe the candidate's educational background:

Please give three examples of how the nominee shows leadership, innovation and initiative in his/her business or occupation. Describe in as much detail as possible.

Please provide three examples of how the nominee has contributed to his/her community. Explain his/her responsibilities and accomplishments in community and/or civic organizations. This may include highlighting any special recognition, awards or projects completed in the past three years.

Describe at least two instances in which the nominee made a difference at his/her workplace or in the community. Explain how he/she has worked to overcome a challenging situation. Describe in as much detail as possible.

Provide two examples of how the nominee has served the community outside of his/her profession. How has the nominee gone above and beyond the call of duty to make a difference?

If you could highlight only one special trait or characteristic about the nominee, what would it be?