Orpha Gatch Citizenship Award Nomination Form

Presented by the League of Women Voters of Clermont County
At the 21st Annual Suffragist Event
Tuesday, August 29, 2017, 6:00 PM
Holiday Inn Eastgate

Criteria: The Orpha Gatch Citizenship Award recognizes the leadership of a Clermont County woman for her outstanding volunteer civic service in our community. The nominee must reside in Clermont County, Ohio and the activities for which the nominee is being recognized must be volunteer. Nominee should symbolize the leadership, energy, optimism and trust of the early suffragists. Women currently running for public office are not eligible for the Orpha Gatch Award. All nominees will be showed cased and honored at the event.

Questions?
Contact Linda Pilon 513-528-4376 and email Linda.Pilon@cinci.rr.com.

Deadline for Nominations:
Submissions must be RECEIVED on or before June 30, 2017.

Nominee:   Name*
  Address*
  City*
  State*
  Zip*
  Home*
  Work*
  Mobile*
  Email*

When completing the following, please use specific examples. Also limit each response to 100 words.

  1. List the nominee's civic and/or community activities that have had a positive impact on Clermont County.*
  2. List the personal qualities or traits that you believe have added to this Nominee's leadership and effectiveness.*
  3. Describe a particular event or activity you believe makes this nominee especially deserving of this award.*
  4. Describe how the Nominee demonstrated initiative and courage.*
  5. Give any additional background information the judges should consider.*
  6. Please list at least at least one additional reference familiar with the nominee's volunteer work.

    Reference Name:*

    Organization:*

    Contact Information:*

Please list names and addresses or email address who you believe should be invited to the event to honor your nomination for this award because all nominee's will be recognized.

Invite:   Name*
  Address*
  City*
  State*
  Zip*
  Email*

Please provide your information.

Nominator:   Name*
  Relationship to Nominee*
  Address*
  City*
  State*
  Zip*
  Phone*
  Email*


* required entry


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