Person Being Nominated (Note: Individuals may nominate themselves.)

1

First Name

 *

2

Last Name

 *

3

Email

4

Phone

ext.

5

Address (Note: Nominee must reside in Moorhead)

 *

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Please answer each of the following questions. Your responses to each question should not exceed 200 words.

6

Describe how the nominee has worked to advance minoritized communities.

 *

7

Describe how the nominee leads with compassion and resilience.

 *

8

Describe ways in which the nominee has been a trailblazer, and broken barriers to create opportunities for others.

 *

9

Describe ways in which the nominee has worked to make Moorhead a welcoming and supportive community for all.

 *

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Thank you for your nomination! Please provide us with your contact information so that we can contact you if your nomination is selected.

10

First Name

 *

11

Last Name

 *

12

Email

 *

13

Phone

 *

ext.

14

Address

15

Does this person/organization know they are being nominated?

 *

Yes

No

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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Code:

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