Office of Children's Affairs
201 W Colfax Ave Dept 1101
Denver CO 80202
phone: 720.913.0900
fax: 720.913.0928
Mayors Youth Award
2015 Nomination Form
The Mayor’s Youth Award honors youth between the ages of 13 and 19 who have overcome adversity to achieve success. The award seeks to recognize and support young people who have made positive changes and exhibited strength and determination in the face of challenges. Aselection process inJanuary 2015 will identify the top thirty youth to be honored at a ceremony with Mayor Michael B. Hancock in April 2015.
In describing your nominee, please be specific as to why he/she should receive this award. When completing the forms, keep in mind that the more information you include, the easier it will be for the screening committee to recognize what makes this young person deserving of the award. We realize that some of the information may be sensitive. Please indicate if any of the information needs to be kept confidential. Due to the nature of many of the young peoples’circumstances, we will not accept a nomination without the consent of the young person represented by their signature on this form. This means he/she has read the nomination and agrees to all that has been submitted.
You will be notified of your nominee’s status no later than February 20, 2015.
Please download and print this nomination form forthe nominee and the nominator to sign. When complete, please scan and email, fax, or mail to the name and address below.
Details
- Nominee must reside in the City and County of Denver.
- Nomination forms must be received no later than the end of the day December 17, 2014.
Nominations will not be accepted after this date.
2. Please indicate if any part of this information should be kept confidential.
3. Nominee’s age as of January 31, 2015must be between 13 and 19 years old.
Complete entire nomination form andscan and email, fax or mail to:
Susan Wells
Office of Children’s Affairs
201 W. Colfax, Dept 1101
Denver, CO 80220
720.913.0904
Mayor’s Youth Award 2014-2015 School Year
Nomination Form
Please enter information in the fields below and fill the form out completely.
PLEASE TYPE OR PRINT LEGIBLY
THIS FORM MUST BE SIGNED BY BOTH THE NOMINATOR AND THE NOMINEE TO BE PROCESSED FOR NOMINATION
Date of Submission:
Nominee Information:
Nominee:______Phone: ______
Address: ______City: County: __ Zip Code:______
Email: ______Grade Level (if applicable): ______
If student, school attending: _____County in which school is located: ______
Nominee’s age as of 1/31/14: __Date of Birth: ______Gender: Male ______Female _____
Nominator Information:
Name: ______Phone:
Mailing Address: ______City: Zip Code:______
Email: ______Relationship to Nominee: ______
To the best of my knowledge, all the information provided in this application is true and reflects the nominee accurately. I have made note of specific information about the nominee that needs to be kept confidential.
Signature of NominatorDate Signature of NomineeDate
Complete entire nomination form and scan and email or mail along with the Nomination Questionnaire to:
Susan Wells
Office of Children’s Affairs
201 W. Colfax, Dept 1101
Denver, CO 80220
720-913-0904 Office Phone
720-913-0928 Fax Phone
Nomination Questionnaire
(Please feel free to use additional sheets of paper to respond to the questions)
Name of Nominee:
- Describe the personal adversity, difficult environment, and/or limitations your nominee has overcome.
- What have been the key factors and supports that helped your nominee turn his/her adversity around?
- How has your nominee helped himself/herself, other youth, their family, or the Denver community?
- At this time where does your nominee seehimself/herself after high school?
- Name one adult (and give contact info) the nominee will identify as their check in person for continuedfollow up.
- Contact Person: ______Phone:
- Address: ______City: Zip Code:______
- Email: ______Relationship to Nominee: ______
Delivering a city where children, youth, and their families have the opportunity to succeed.