Sandy Clark Community Award Application

The “SANDRA M. CLARK COMMUNITY SERVICE AWARD” was created to honor persons who are making significant contributions to their community. The honoree selected should be a dedicated volunteer, who promotes the welfare of Delaware Youth and their families.

Nominee Name:(required)

Address:(required)

Email(required)

Phone Number(required)

Part B – Volunteer Service

List community service activities in which the nominee has participated, the number of total hours devoted to the activities and responsibilities those activities entailed:

Activity #1

Dates of participation:

Total hours:

Name and type of organization:

Supervisor:

Nominee’s responsibilities at this organization?

Activity #2

Dates of participation:

Total hours:

Name and type of organization:

Supervisor:

Nominee’s responsibilities at this organization?

Activity #3

Dates of participation:

Total hours:

Name and type of organization:

Supervisor’s Name:

Nominee’s responsibilities at this organization?

Total hours volunteered with this organization:

Part C: Please note any additional factors that our committee should consider inmaking our decision? (other awards/recognition received, etc.)

My submission indicates that all information contained in this application is factually correct and honestly presented. I am not an immediate family member of the Delaware Juneteenth Association, member of the board of directors or award committee.

APPLICATION DEADLINE: TUESDAY SEPTEMBER 15, 2020

Nominator:

Date:

For Email Submission: Email to DelawareJuneteenth@gmail.com

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