Application Submission Date *

Nominator Information

Nominator First name *

Nominator Last Name *

Nominator Organization Name

Nominator Title

Nominator Email *

Nominator Phone *

Nominee Information

Nominee First name *

Nominee Last Name *

Nominee Organization Name

Nominee Title

Nominee Email *

Nominee Phone *

Nominee Organization Address

Please select one award for your nomination *
Leaders in Justice:Young Professional:Accessing Justice:Ally Awards:Community Service:Defender of Justice:

Please describe why your nominee should be considered for this award *

Please share whether nominee lives in, works in, impacts Union County. (check all that apply) *
Lives in Union CountyWorks in Union CountyImpacts Union County

Please indicate if you would like your nominee notified of this award submission upon completion of this form? If YES, they will be copied on the confirmation email.
YesNo

Would you like this nomination to be anonymous (we will not tell the nominee who nominated them)?
YesNo