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The Fort Collins Human Relations Commission HUMAN RELATIONS AWARD NOMINATION FORM

2014

CRITERIA: Every year the Human Relations Award recognizes those in our community who promote acceptance and respect for diversity in the City of Fort Collins. Nominations are taken in the five different categories outlined below.

The award process considers the length of service and commitment to the community. Anyone who has not previously won the Award is eligible for consideration. There are no Fort Collins residency requirements.

The deadline for submitting and returning nomination forms is October 15.

Nomination Categories:
There are 5 categories for the Human Relations Awards. (To nominate in more than one category, you will need to submit a separate nomination form for each category.) Please check the appropriate category for your nominee:
Nominee Contact Information (Required):
* Name of Individual/Organization:
* Home Address:
Home Address (continued):
* City: * Zip:
* Phone:
 
* Business Address:
Business Address (continued):
* City: * Zip:
* Phone:
* Current Occupation (individual):
* Name of President/Executive Director or Organization's Representative:
E-mail (if available):
Website (if available):
Purpose of organization (if applicable):
About Your Nominee:

NOTE: Please respond in detail and submit additional attachments if necessary. Additional attachments can be submitted on-line or mailed to the H.R.C., c/o Human Resources, PO Box 580, Fort Collins, CO 80522. Should this nominee become the recipient, the information provided will be used for the presentation introduction and for publicity. Therefore, it is important that all information be correct, complete and specific.

Please answer as many of the following questions as possible. The nominee does not need to fulfill all of the criteria below. However, answers to these questions will provide the selection committee with an in-depth understanding of the nominee’s service to the Fort Collins community.

  1. How many individuals (approximately) does this person or organization serve?
  2. Please describe in detail how this individual or organization is meeting the needs of a minority/disadvantaged population.
  3. How many individuals (approximately) has this person or organization motivated to serve others?
  4. Please give a detailed example of how this person or organization motivated others to serve.
  5. Has this person or organization been recognized for serving others? If so, please explain.
  6. How long (approximately) has this person or organization been involved in serving others?
  7. Is this person or organization serving as a direct result of an emergency or immediate need? "Yes" or "No" are appropriate answers. However, if explanation is needed, please elaborate.
  8. Please give additional examples and information in support of your nomination.
*  
Additional attachment
(optional):
Reference (Optional):
Reference Name:
Home Address:
Home Address (continued):
City: Zip:
Phone:
E-mail (if available):
Nominator Information (Required):
Person or group making nomination:
* Home Address:
Home Address (continued):
* City: * Zip:
* Phone:
* Business Address:
Business Address (continued):
* City: * Zip:
* Phone:
E-mail (if available):
Relationship to nominee:
How Did You Learn About the Human Relations Award?:
Other (Please specify):
* denotes required field