Local Volunteer of the Year Nomination

United Way:	Adams Co. Allen Co. Bartholomew Co. Blackford Co. Cass Co. Clinton Co. Danville Area Daviess Co. Decatur Co. DeKalb Co. Delaware Co. Elkhart Co. Fayette Co. Floyd Co. Franklin Co. Fulton Co. Gibson Co. Grant Co. Grt. Lafayette Grt.Cincinnati Harrison Co. Henry Co. Howard Co. Huntington Co. Jackson Co. Jay Co. Jefferson Co. Jennings Co. Johnson Co. Knox Co. Kosciusko Co. LaGrange Co. Lake Co. LaPorte Co. Madison Co. Marshall Co. Metro UW Miami Co. Monroe Co. Montgomery Co. Noble Co. Perry Co. Pike Co. Porter Co. Posey Co. Pulaski Co. Putnam Co. Randolph Co. Rush Co. Scott Co. Shelby Co. South Central IN Southwestern IN St. Joseph Co. Starke Co. Steuben Co. Switzerland Co. Tipton Co. UWCI Wabash Co. Wabash Valley Wells Co. White Co. Whitewater Valley Whitley Co.
Respondant's Email:
Respondent's First Name:
Respondent's Last Name:
Respondent's Position:
This nomination is a secret:	Yes No
Nomination Type:	Individual Company
VOY or Company Representative First Name:
VOY or Company Representative Last Name:
VOY Title:
Company Name
A special invitation will be sent to VOY (if not secret nomination). Please provide address.
VOY Address:
VOY City:
VOY State:
VOY Zip:
VOY Phone:
Describe (in aprox. 150 words, maximum 820 characters) why your volunteer or company was chosen. This will be read to the audience at the banquet.
Items in Red Are Required

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