2025-2026 BYA RECOGNITION NOMINATION FORM
Thank you for helping us celebrate and recognize our outstanding adult and youth citizens. If you have any questions or if you would like to submit supporting documents, please email: byarecognition@bloomfield.org. Please submit nominations by January 31, 2026.
Type of nomination? (please submit a different form for each nominee)
Adult
Youth/Student
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Adult Nomination
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Nominee's Full Name:
*
First Name
Last Name
Nominee's Email Address
*
example@example.com
Nominee's Phone Number
*
Please enter a valid phone number.
Tell us about the nominee and their contribution to the community:
*
Please note: If your nominee is selected, you should be prepared to write and present a 2-3 minute statement based on this information at the award ceremony.
0/250
Is the nominee aware of this nomination?
*
Yes
No
Not yet
Are you able to attend the awards ceremony on April 27, 2026?
Yes
No (I will submit a 2-3 minute speech to be read on my behalf)
Not sure
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STUDENT NOMINATION
Parents/guardians, siblings or other relatives of the nominee are restricted from nominating.
Your Full Name
*
First Name
Last Name
Your Email
*
example@example.com
What is your affiliation with the student?
*
Please Select
School Counselor
Teacher
Community Leader
Family Friend
Other
Student's Full Name
*
First Name
Last Name
Student's Email
*
example@example.com
Parent/Guardian Name(s)
*
First parent/guardian
Second parent/guardian
Parent/Guardian Email
*
example@example.com
Which school does the student attend?
*
How long you have known the student?
*
What is the current grade of the student?
*
Must be in 6th - 12th grade
With which school/community organization are you affiliated?
*
Does your nominee reside within the Bloomfield Hills School District boundaries? Link to the district map: https://www.bloomfield.org/why-bloomfield/enrollment-options/district-boundarymap?
*
Yes
No
Not sure
Is the student aware of this nomination?
*
Yes
No
Not yet
This nomination is made under which category? Choose one category only.
*
Volunteer service to an individual, organization, or to the community
Personal acts of leadership and/or heroism
Self-improvement through personal and/or academic achievement
Remarkable perseverance through hardship or tragedy
Initiation of a new program or project to help others
Please describe your nominee's experience and include as many details as possible. If this was related to a volunteer experience please list all of the activities, total hours accumulated and the objectives of the project.
*
Please note: If your nominee is selected, you should be prepared to write and present a 2-3 minute statement based on this information at the award ceremony.
0/500
Are you able to attend the awards ceremony on April 27, 2026?
Yes
No (I will submit a 2-3 minute speech to be read on my behalf)
Not sure
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Would you like to submit another nomination?
YES
NO
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Unfortunately, Bloomfield Youth Assistance is limited to awarding students who live within the Bloomfield Hills Schools district boundaries. Please reach out to the student's local Youth Assistance office.
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BYA appreciates your nomination!
If you have any questions or if you would like to submit supporting documents, please email: byarecognition@bloomfield.org.
Submit
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