Hispanic Heritage Month Nomination

Hispanic Heritage Month Nomination Form

Submit a nominee’s details and a brief description of their community contributions.
Eligibility Criteria

Nominee must live or work in Rockland or their place of business must be in Rockland. Nominee must be of Hispanic heritage and a contributing member of the community.
Name of Nominee

First NameLast Name
Business (if applicable)
Nominee Email/Phone
Describe how the nominee has contributed to the community
This nomination submitted by
Your Name

First NameLast Name
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Email
example@example.com
Should be Empty:

Hispanic Heritage Month Nomination Form