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Valley Outreach “Take a Stand” Award This award will be given to an individual or group who had the courage to take a stand against bullying and harassing behavior in our community and did an activity that promoted a culture of respect. The award will be announced at the Valley Outreach After-Hours The nomination committee will be made up of a panel representing youth, business, non-profit agencies, education, and parents. Please send your nomination form to Suzette Indelicato, Executive Director of Starting Point PO BOX 1972, CONWAY, NH 03818, e-mailed to edirector@startingpointnh.org, or by fax (603) 452-5302 by March 1, 2010. --------------------------------------------------------------------------------------------------------------- Name of Nominator: ______________________________________________________ Address: ______________________________________________________________ Phone number: _________________________________________________________ How does nominator know this group or individual and for how long: _____________ _______________________________________________________________________ _______________________________________________________________________ Name of Person/Group being nominated: ___________________________________ Address: ______________________________________________________________ Phone number: _________________________________________________________ Please describe in detail what the nominee has done to deserve this award ( feel free to use back page or separate sheet for your explanation) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ |