Outstanding Environmental Volunteer Award Nomination Form

Rockland County Executive’s
Outstanding Environmental Volunteer Award
Nomination Form

Nominee Information:

Individual
18 years or older
Rockland County resident
Individuals who have been nominated in the past, but not chosen, are eligible to be re-nominated. Please update and re-submit the past nomination for consideration again this year.

Improvements to Rockland's environment
Volunteer involvement and coordination
Efforts to protect and preserve the environment
Use of innovative approaches to beautify the community
The ability of the individual’s program or activity to serve as a model
Number of years of environmental volunteer service (more years of service, the better)

Name

First NameLast Name

Affiliation

For none, please enter "None" or "NA"

Position

For none, please enter "None" or "NA"

Address

Street Address

Street Address Line 2

CityState

Zip Code

Email*

example@example.com

Phone Number

Name

First NameLast Name

Affiliation

For none, please enter "None" or "NA"

Address

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Email

If you do not enter an email, you will not receive a confirmation of your nomination.

Using the area below, please write a 100-150 word synopsis of the nominee's accomplishments for which award recognition is sought. Please include in your synopsis, how your nominee accomplished each criteria listed above.
Reasonable amount of supporting materials (e.g., testimonials, news clipping or other material) to provide a view of the nominee's efforts. Materials cannot be returned. You may scan hard copy materials or take a picture with your smart device and upload the files below. You may enter links to videos (i.e. YouTube, Facebook, etc.) in the video links field below. Video files uplaods are not permited on this form.

If you are unable to upload digital media please use our paper form.

File size for EACH file is limited to 10 MB, 15 file maximum. File types are limited to: jpg, jpeg, png, gif, pdf, doc, docx, ppt, pptx

Synopsis:

Upload Supporting Documentation:

You may add multiple files. Click "Select Files" to add more files.

Video Links (Enter each link on a new line):