Wib and June Justi Community Service Nomination Form
Submission Deadline: September 1st
Nominee Name
First Name
Last Name
Nominee's State
Nominee Grange Name & Number
Nominee Phone Number
Please enter a valid phone number.
Nominee Email
example@example.com
Name of Person or Grange Submitting Nomination
Chairperson's Name
First Name
Last Name
Chairperson's Email
example@example.com
Chairperson's Phone Number
Please enter a valid phone number.
Please explain how this young Granger embodies a positive attitude for service.
Describe a specific project that this individual has taken part in and tell who benefitted from the project? Was this a new or ongoing project?
What kind of impact or results has the Grange and/or community seen as a result of this individual’s service?
Feel free to add additional details about this individual’s serving nature.
Please verify that you are human
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