Cultivating, Connecting and Engaging Leaders in Working Together
for Community Excellence,
Pride and Progress
WILBUR AWARD - THE POWER OF ONE
NOMINATION FORM
I. NOMINEE ____YOUTH ____ADULT ____ORGANIZATION
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Nominees Name
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Street City/State/Zip Code
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Daytime Telephone # Email Additional Information for Youth
Nominees:
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School Currently Attending Current Grade Level
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Parents Name(s) Telephone # II. NARRATIVE INFORMATION: List the
accomplishments/ activities during the past year that make this
Nominee deserving of recognition:
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Wilbur Award Nomination Form - Page 1
List any additional information about the Nominee which you feel
would be pertinent to this nomination:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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Please feel free to attach additional pages. III. NOMINATING
INDIVIDUAL
____________________________________________________________________________
Name
____________________________________________________________________________
Telephone # Email (required; confirmation of receipt of nomination
will be sent to this address.) Where did you hear about LTs Wilbur
Awards and nomination process? ____Texarkana Gazette ____TV
____Radio____Texarkana Community Journal, ALT, Four States Living
Magazine____Leadership Texarkana website ____Leadership Texarkana
Facebook ____Leadership Texarkana Email Blast ____Chamber of
Commerce Eml Blast____Other (Please specify):
_____________________________________________________________________________
If you would like to include other information with this
nomination, please attach to the nomina-tion form and either email
the complete nomination package to [email protected]
or
mail to Leadership Texarkana, P.O. Box 311, Texarkana, TX,
75504.
IF YOU HAVE NOT RECEIVED CONFIRMATION OF RECEIPT OF YOUR
NOMINATION within seven days of submitting, please contact
Leadership Texarkana at 903.792-0011.
Nomination form is also online at LeadershipTexarkana.com.
Wilbur Award Nomination Form - Page 2
Revd 2.3.14
