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*

Nominator Information

Nominees can be nominated by an organization – only one nominee per organization. Or, an individual may also nominate a nominee – a minimum of two nominators is required for each individual nominee.

Nominator One Info

Name of Nominator*

First

Last

Nominator Employer

if applicable

Nominator Title

if applicable

Nominator Address

Nominator City

Nominator State

Nominator Zip

Nominator Mobile Phone

Nominator Work Phone

Nominator Email address*

Tell us why you believe this nominee is deserving to be the 2021 Fernando Award recipient*

(Maximum of 750 characters)

Nominator Two Info

Name of Nominator*

First

Last

Nominator Employer

if applicable

Nominator Title

if applicable

Nominator Address

Nominator City

Nominator State

Nominator Zip

Nominator Mobile Phone

Nominator Work Phone

Nominator 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. To add volunteer information, click the “down-arrow” on the number of organizations. Once you identify the number of organizations you wish to document, 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*

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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