Appointment Request

The first page of this form is to nominate an individual for Philanthropist of the Year. The second page is for you, the nominator, to fill out with your information.

The criteria for this award show excellence in the following areas:
- individual's (or couple's) direct contribution to and support of JRMC and JRMC Foundation
- leading others to be involved in philathropy or community volunteer service
- exemplifies a spirit of exceeding expectations and being THE difference in the lives of those they serve
Nominee(s) Name*

FirstLast
Mailing Address*

Address Line 1

Address Line 2

CityState

Zip Code
Phone Number*
Email*
Organization

Nominator Name*

FirstLast
Relationship to Nominee*
Mailing Address*

Address Line 1

Address Line 2

CityState

Zip Code
Phone*
Email*
Organization
Please use the award criteria to tell us more about what makes this individual an ideal candidate for the Philanthropist of the Year award.*
Should be Empty: