Leadership Award

Nominee:

Address:

Phone Number:

Your Name:

Address:

Phone Number:

Email Address:


Situation nominee has created a solution for:


Did nominee solve this problem by himself/herself? Who else was involved in initiating the solution?


How has this made a difference in the lives of others? Who has benefited from the solution?


Is the nominee still involved in the solution/program? If so, how?


Has the nominee motivated others to actively get involved? Has the nominee inspired others to solve problems in their neighborhood?


Does this go beyond the scope of the nominee's job? Was the nominee paid for his/her work in creating the solution?


How long has the nominee worked on the program?


What sacrifices has the nominee made in order to ensure the success of the program?


Additional Comments:

The information submitted is for the sole purpose of determining a KERO Leadership recipient.