Distinguished Civic Leadership Awards Nomination Form
The Civic and Community Engagement and Research Project (CCERP) is soliciting nominations for
annual awards to be made at its Civic Engagement Recognition Banquet in April 2014. The purpose of these
awards is to publicly recognize notable civic/community contributions on the part of individuals and entities
that have had a positive impact locally, regionally, nationally or internationally. Nominees may fall into one
of the following eligible categories:
an MU faculty or staff member
an MU student
an MU alum
an MU Club or non-profit organization
We respectfully request that you make a nomination or nominations by providing
the information requested below.
The award recipients will be selected based on the following criteria:
1. Nominee falls into an eligible category.
2. Nominee has made a significant contribution(s) to the local, regional, national or
international community.
3. Nominee’s leadership or actions have benefited others or the community.
4. Nominee’s leadership inspires or empowers others to become civically involved.
Responses are due by March 10th, 2014.
CCERP Distinguished Civic Leadership Awards
Millersville University of Pennsylvania
Huntington House
8 South George Street
Millersville, PA 17551
Or community.engagement@millersville.edu
Please indicate the category for which your nomination is being made:
______________________________________________
Nominator:
Address
City
Title/Position
Email Address:
Nominee
Address
City
Email Address:
State
Zip
Phone (
)
State
Zip
Phone (
)
(If chosen, nominees will be contacted and may be asked to provide additional information)
Please answer the following questions typewritten in the space provided; if necessary
additional comments can be submitted on a separate sheet of paper.
1. Describe the achievement(s) or service(s) on which the nomination is based. (Please include dates and/or
a timeframe).
2. Tell us how the aforementioned achievement(s) or service(s) have benefited others or the community.
Please be as specific as possible.
3. Tell us how the nominee is a positive role model for others, and inspires others to become civically
involved.
4. Explain how the selection of this nominee could help promote the cause(s) with which he/she is
associated.
Signature of Nominator:___________________________________
Date:
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