Nomination Form Nominee InformationNominee NameFirstLastNominee EmployerIf applicableNominee TitleIf applicableNominee Address*Nominee City*Nominee StatePlease selectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingNominee Zip*Nominee Mobile PhoneNominee Work PhoneNominee Email Address*Nominator InformationA maximum of two (2) nominators are required for each nominee.Nominator One InfoName of Nominator*FirstLastNominator Employerif applicableNominator Titleif applicableNominator AddressNominator CityNominator StateNominator ZipNominator Mobile PhoneNominator Work PhoneNominator Email address*Tell us why you believe this nominee is deserving to be the 2021 Fernando Award recipient(Maximum of 750 characters)Nominator Two InfoName of Nominator*FirstLastNominator Employerif applicableNominator Titleif applicableNominator AddressNominator CityNominator StateNominator ZipNominator Mobile PhoneNominator Work PhoneNominator Email address*Tell us why you believe this nominee is deserving to be the 2021 Fernando Award recipient(Maximum of 750 characters)Volunteer Information Please list organizations where you currently or previously serve/served as a volunteer. We also request the approximate dates of the volunteer service (1999-present or 1999-2005, as an example). List the positions you held as a volunteer. Some positions might include the following (please be as specific as possible such as “program committee chair, gala dinner chair/committee member, etc.) This is not an exclusive list of volunteer positions held and listed here only as some suggestions.Number of OrganizationsPlease select123456789101112131415Organization OneOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization TwoOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization ThreeOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization FourOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization FiveOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization SixOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization SevenOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization EightOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization NineOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization TenOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization ElevenOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization TwelveOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization ThirteenOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization FourteenOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherOrganization FifteenOrganization Name & CityIf multiple locations, list HQ or primary Sf Valley locationVolunteer Dates of ServicePosition(s) HeldPlease selectBoard officer such as chair, vice chair, secretaryBoard memberBoard ex-officioProgram chair, co-chair, program committee memberCommittee chair, committee memberSpecial event chair (be specific for which event or events)OtherNominee Questions Nominee's shall answer the following questionsWhy 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 UploadsPhoto Upload*Recent, high resolution headshot, in colorBiographical Resumé Upload*Maximum two-page professional bio-sketch or resumeAttestationBy checking this box, I hereby attest that all information provided on this form is accurate and truePlease type the characters*This helps us prevent spam, thank you.SubmitThis field should be left blank
