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2015 City of Elk River Sustainable Community Award <br /> Official Nomination Form <br /> Nominee: Indicate Mr., Mrs., Ms., Miss Today's Date: <br /> Applications are valid from 6 months from the time of submission <br /> Name: <br /> Address: <br /> City: State: Zip: <br /> Daytime Phone Number: <br /> Email address: <br /> Please check the appropriate age classification for your nominee: <br /> ❑ Youth (18 and under) ❑ Young Adult (19-25) ❑ Adult <br /> ❑ Senior (55 and over) ❑ Group <br /> Verification: To qualify, the nominee must have one reference who may be contacted to verify the scope and extent <br /> of the nominee's activities. Reference should be a person familiar with the community service activities for which <br /> the nomination is made and should not include either the nominee or any persons related to the nominee. The <br /> reference below must be someone other than the nominator. <br /> Reference: <br /> Name: <br /> Daytime Phone Number: <br /> Address: <br /> City: State: Zip: <br /> Agency/Organization: <br /> Nominator: <br /> Name: <br /> Daytime Phone Number: <br /> Address: <br /> City: State: Zip: <br /> Agency/Organization: <br /> Signature: <br /> n:Apublic bodies\agenda packets\04-20-2015\final\x11.2 attl sustainability award application.docx <br />