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 InformationNominees can be nominated by an organization – only one nominee per organization. Or, an individual may also nominate a nominee – a minimum of one nominator and a maximum of two nominators requested for each individual nominee. Number of Nominators*Please select12Nominator 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. 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 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 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 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*Typing in these characters helps us prevent unauthorized use of this online nomination form. Thank you.SubmitThis field should be left blank
