Citizen Nomination Form

Citizen Primary Nomination

Step 1 of 5 -
* = Required

Nominee Information

Citizen/Volunteer's First and Last Name*
First Last
Is a Second Person Being Nominated for the Same Project/Activity?
Second Citizen/Volunteer's First and Last Name*
First Last
Name of Project/Activity to which criteria will apply*
Position*
Length of Time in Position*
Length of time Citizen/Volunteer has been involved with project/activity
Citizen/Volunteer's Phone Number*
Citizen/Volunteer's Address
Street Address Address Line 2 City State ZIP Code
Citizen/Volunteer's Email*
Second Citizen/Volunteer's Phone Number*
Second Citizen/Volunteer's Address
Street Address Address Line 2 City State ZIP Code
Second Citizen/Volunteer's Email*

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Brief Description of how the Project or Activity Works*
School Affiliation (can be private or public within Lake Oswego)
Is this a New or Ongoing Project/Activity
Project/Activity Start Date (estimate if needed)
Will this Project or Activity Continue into the Future?
Number of People Benefited (estimate if needed)
How are You Familiar with this Person's Service to Others in Support of Education? (What is your connection to the Nominee?)

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Shows initiative, yet demonstrates selfless conduct toward others (give examples where you can).
a) How did Citizen/Volunteer initiate the project/activity or show personal initiative in performing it?
b) How much time did Citizen/Volunteer invest in the project/activity?
c) Does the project/activity meet a school need? How?
d) Does the project/activity meet a community need? How?
e) How is the Citizen/Volunteer an inspirational leader who engenders support of other involved stakeholders?
Inspires others to reach a high level of educational excellence (give examples where you can).
a) Does the Citizen/Volunteer create a positive learning environment that impacts others?
b) How does the project/activity involve critical thinking?
c) How does the project/activity demonstrate and engender high educational ideals?
d) Did project participants learn new skills through their involvement with the project?
Builds a strong sense of confidence, competence, and citizenship in others (give examples where you can).
a) How did the project/activity encourage mutual trust and empowerment?
b) How was the Citizen/Volunteer effective in communication, organization, creativity?
c) How did the Citizen/Volunteer motivate citizenship in others?
d) How many people were involved in executing the project/activity?
Creates positive, results-driven impact that could continue beyond the Citizen/Volunteer's involvement (give examples where you can).
a) Has the project/activity been a measurable success (if possible, provide numbers)?
b) How will it be measured in the future?
c) How did Citizen/Volunteer's project/activity result in a sustainable model for others to follow?
Participates in a high level in other extracurricular & school-related activities (give examples where you can).
a) In which extracurricular and school-related activities is the Citizen/Volunteer most involved? How?
b) In which does the Citizen/Volunteer have a significant or leadership role? How?
c) In what other community activities outside of the classroom does the Citizen/Volunteer participate?
Is there anything you would like to add that is not addressed in your answers above?

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Nominator Name*
First Last
Nominator Address
Street Address Address Line 2 City State ZIP Code
Nominator Phone Number*
Nominator Email*

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Who Will you be asking for a supporting nomination of your Nominee?
At least one Supporting Nomination is necessary for each Nominee. Please contact one or two other individuals who are familiar with your Nominee and their project/activity and request that they complete the 'Supporting Nomination' form (found on this website).

Include the name and email of at least one person. If you have more than one person to provide a supporting nomination, include a name and email for each person.

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Citizen Primary Nomination

Step 1 of 5 - * = Required

Nominee Information

Step 1 of 5 -
* = Required