IGNITE NOMINATION APPLICATION 2021 Ignite Nomination Form Name of Nominee* Company/School/Organization of Nominee* Nominee Title or Year and Major* Nominee Street Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Nominee Phone*Nominee Email Address* Enter Email Confirm Email Nominator Name* Nominator Company/Organization* Nominator Phone*Nominator Email* Enter Email Confirm Email Award Category (.5 pt)*Corporate/Company Volunteer of the YearCommunity Volunteer of the YearFaith-Based Volunteer of the YearGovernment Volunteer of the YearNonprofit Volunteer of the YearStudent Volunteer of the YearSmall Business Volunteer of the YearUnited Way Hands On Volunteer of the YearI. Record of Service (8 pts)Please answer the following questions to the best of your ability and include supporting documentation, if at all possible.1. What need did the nominee's service fulfill in the organization/community? (3 pts)*2. How many years has the nominee volunteered in the community? (2 pts)*1-5 years6-10 years11-15 years15+ years3. How did the nominee set an example for other volunteers? (3 pts)*II. Impact Area (3 pts)1. Into which impact/categories does the nominee's service fall? Check all that apply.*Access to servicesArtsCultural/religious/spiritual enrichmentEducationEnvironmentalFinancial literacy/stabilityHealthHuman ServicesSenior ServicesVeterans supportOtherII. Service Area (1 pt)1. In which county did the nominee's service take place? Check all that apply.*BlountJeffersonShelbySt. ClairWalkerOtherIV. Commitment (10 pts)1. Did the nominee initiate programs or activities and/or develop new methods to streamline operations, solve problems or assist in service delivery? If so, describe how: (5 pts)*2. Was the nominee dependable and punctual? (2 pts)* Yes No 3. Did the nominee overcome any challenges/barriers to complete tasks and achieve goals? If so, explain. (3 pts)* V. Personal Impact (4 pts)1. Describe how the nominee's unique skills and talents helped the organization/community. (3 pts.)*2. Did the nominee complete tasks in a timely manner? ( 1 pt.)* Yes No Letter of Support (1 pt)*Max. file size: 15 MB.Letter of Support - 2Max. file size: 15 MB.Letter of Support - 3Max. file size: 15 MB.Supplemental Documentation (1 pt)Max. file size: 15 MB.Supplemental Documentation 2Max. file size: 15 MB.Supplemental Documentation 3Max. file size: 15 MB.Nominee Picture (1 pt)*Max. file size: 15 MB.Nominator Name* First Last I agree that this information is true and accurate to the best of my knowledge.Date* MM slash DD slash YYYY CAPTCHA Δ
