Ron Kohn Servant Leadership Award Nomination Form
This award is meant to recognize a public servant that has gone above and beyond to provide exceptional leadership and contributions to a local city or county (from Cass, Fremont, Harrison, Mills, Montgomery, Page, Pottawattamie, or Shelby County). Nomination deadline is August 25, 2026.
Nominated Person
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City/County/Entity
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Position
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Is this person an elected official, government employee, or an appointed member of a government board or commission?
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Yes
No
E-mail
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Phone Number
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-
Area Code
Phone Number
Nominator:
Person submitting the nomination
Full Name
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First Name
Last Name
Entity
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Position
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E-mail
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Phone Number
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-
Area Code
Phone Number
Would you be willing to present the award to your nominee at the SWIPCO Annual Meeting on September 24, 2026?
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Yes
I'm fine with being mentioned as the nominator but can't present.
I would like to remain anonymous.
Nominee Role Information
Please list the various positions or roles your nominee has held in civic leadership.
Describe
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Nominee Support Information
Please describe why you feel your nominee is deserving of receiving the Ron Kohn Leadership Award. We encourage examples of successful leadership, educational efforts, and accomplishments.
Describe
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Submit
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