355 FRANKLIN D. ROOSEVELT, HATO REY, PR 00918 | 787.764.6363

A.

Name:

Sex:

Physical address:

Postal address:

Telephones Home:

Email:

__________________________________________________________________________________________

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__________________________________________________________________________________________

_________________________________________ Mobile: ____________________________________

____________________________________________

Other: _________________________________

Filing date application

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Day Month Year

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B. Nominee’s Personal information

Name Initial Paternal’s Last Name Maternal’s Last Name

M F Age: Date of birth:____________________________________

C. Endorsed By

Mayor’s name:

Municipality:

O�ce telephone:

Email:

__________________________________________________________________________________________

__________________________________________________________________________________________

_________________________________________

____________________________________________

Alternate telephone: _________________________________

Signature: __________________________________________________________________________________________

D. Choose category

Leadership

Community Service and/or Voluntary Work

Art, Culture and/or Sports

Entrepreneurship

Featured in Science and/or Technology

E. Include the following documents

• Copy of authorized photo ID or passport

• Mayor’s Letter of Recommendation

• Water, Electricity or Telephone service invoice receipt

• Nominee’s Biography

• Citizen Letter of Recommendation - Municipal Bona Fide

DEADLINE: SEPTEMBER 25, 2020 | SUBMIT BY EMAIL: juventud@ddec.pr.gov

PREMIO JOVEN DESTACADO MUNICIPAL

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____________________________________Day Month Year Place of Birth

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