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Local
Nomination Form
Nominate someone you know for a local community award. The process is simple.

National
Nomination Form
Nominate a deserving individual for a national award.


Because of our respect for privacy we will not contact the nominee or nominator until given permission by the Media Partner's Jefferson Awards Coordinator. If you have any questions concerning our process send us an email requesting our guidelines.

Step 1 : Nominee information
In this section we require information on the individual being nominateed for a Jefferson Award.

First Name
Last name
Email Address
Address 1
Address 2
City
State
Zip Code
Home phone number
Work phone number
Local media partner

Step 2 : Nominator information
In this section we require information on the individual who is nominating xxx.

First Name
Last name
Email Address
Address 1
Address 2
City
State
Zip Code
Home phone number
Work phone number

Step 3 : Summary Sentence
In this section we require information on the individual who is nominating xxx.

Step 4 : Outstanding Personal Acts
Here is an ordinary individual performing outstanding personal acts. This individual stands out for taking extra steps. The individual acts were “outstanding”… “unique”…”heroic.”

Step 5 : Community Impact
Beside the heroic acts of the individual, the individual has positively impacted the community. The acts of this individual helped hundreds of others. Look at the change or improvement that this individual was responsible for while addressing important issues facing our community.