Marion Nichols Service Award Nomination Form
Submission deadline: April 7, 2023
Nominee's Full Name
*
First Name
Last Name
Organization
Title
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Nominator's Full Name
*
First Name
Last Name
Organization
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Relation to Nominee
*
Describe how this person embodies the Marion Nichols Service Award.
*
Thank You!
The award will be presented at the 2023 Summit on Homelessness and Housing, May 23-24 at the Prairie Band Casino & Resort in Mayetta, Ks. We would like the selected nominee to be present to receive the award. KSHC staff will contact the nominator to inform them that their nominee won by April 21, 2023.
Submit
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