2022 Nomination Form

Nominee Information

Nominee Name*

First

Last

Nominee Employer

If applicable

Nominee Title

If applicable

Nominee Address*

Nominee City*

Nominee State

Nominee Zip*

Nominee Mobile Phone

Nominee Work Phone

Nominee Email Address*

Volunteer Information

Please list organizations where you currently or previously serve/served as a volunteer. We also request the approximate dates of volunteer services such as 1999-present or 1999-2005, etc. List the positions you held as a volunteer. Some positions might be described as board chair, vice chair, program chair, etc. The application does not include an exclusive list of volunteer positions and are listed, only as suggested positions. To add volunteer information, click the “down-arrow” on the number of organizations. Once you identify the number of organizations, the appropriate number of templates will appear.

Number of Organizations*

Organization One

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Two

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Three

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Four

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Five

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Six

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Seven

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Eight

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Nine

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Ten

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Eleven

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Twelve

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Thirteen

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Fourteen

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Organization Fifteen

Organization Name & City*

If multiple locations, list HQ or primary SF Valley location

Volunteer Dates of Service*

Position(s) Held*

Nominee Questions

The responses to the following questions are to help the Fernando Finalist Selection Committee better understand you, as a Fernando nominee. Please answer each question (750 characters, maximum).

Why do you volunteer in the community?*

(750 characters max)

How did you get started in volunteer service? *

(750 characters max)

Why do you continue to serve as a volunteer?*

(750 characters max)

File Uploads

Photo Upload*

Recent, high resolution headshot, in color

Biographical Resumé Upload (two pages maximum)*

Maximum two-page professional bio-sketch or resume.

Attestation

By checking this box, I hereby attest that all information provided on this form is accurate and true

Please type the characters*

Typing in these characters helps us prevent unauthorized use of this online nomination form. Thank you.

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