Jynny Retzinger Community Service Award - Board Recognition
This application is to be completed by the individual nominating the person to be recognized by the Board of Trustees.
Part 1
The information in this part pertains to the person nominated to be recognized.
Name
First Name
Last Name
Title
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Current Employer
Number of years Employed
Capacity
Employee
Volunteer
Job Duties
Past Employer
Number of Years Working or Volunteering in the Service of People With Developmental Disabilities
Part II
The information in this part must detail the accomplishments or contributions made by the person to be recognized. This information should be completed by the individual making the nomination. Two additional letters of recommendation must accompany the application and support the accomplishments/contributions made by the person to be recognized: (Attach additional comments if needed.)
Accomplishments or Contributions Made by the Person to be Recognized
Accomplishments or Contributions Made by the Person to be Recognized
Other Comments
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Part III
This section pertains to the person making the nomination.
Name
First Name
Last Name
Title
Agency
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email Address(Required)
*
Confirmation Email
Please Describe Your Relationship to the Person You are Nominating. Include How Many Years You Have Known The Person.
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