UPDATED VOTIN GORM 325

10Th Anniversary / 1st Annual CHIPy Awards Nomination Form

The following are award categories for the upcoming ceremony. Please complete this form to nominate those who provide critical social services, support vulnerable populations, and innovate solutions to pressing local challenges.

NAME OF EXECUTIVE DIRECTOR

AGENCY NAME

AGENCY WEBSITE

PHONE NUMBER

EMAIL ADDRESS

example@example.com

ADMINISTRATIVE EMPLOYEE NAME

Reason you think they should be recognized

CLIENT SERVICES EMPLOYEE NAME

Reason you think they should be recognized

AGENCY MISSION STATEMENT

AGENCY PROGRAM SUMMARY