Nominator's Name: _______________________ Telephone Number: _______________________

Address: __________________________ City/State/Zip: ____________________

Nominee's Name/Group Contact: _____________________________________
Adult_____ Teen_____ Group_____
Address: _____________________________ City/State/Zip: ________________________
Telephone Number: _______________________________

Frequency of Service: ____________________

Primary Volunteer Activities:
_____Transportation
_____Contributes one on one
_____Provides group entertainment
_____Provides service to clients
_____Other (please be specific)

In no more than 250 words, explain what makes your Volunteer of the Month nominee special. In your nomination, please direct your statements to the criteria of the nomination, benefit to the organization, responsibility to the organization, dedication to the organization, and promotion of volunteerism. Please type your comments on a separate sheet.

United Way & Volunteer Services
P.O. Box 387, Yankton SD 57078
605-665-6766 231 Broadway
unitedway@iw.net