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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin 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: 200 MB.Letter of Support - 2Max. file size: 200 MB.Letter of Support - 3Max. file size: 200 MB.Supplemental Documentation (1 pt)Max. file size: 200 MB.Supplemental Documentation 2Max. file size: 200 MB.Supplemental Documentation 3Max. file size: 200 MB.Nominee Picture (1 pt)*Max. file size: 200 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
