NPD Nomination Form

Thank you for taking the time and effort to submit a National Philanthropy Day nomination. This online form is not designed to save your work for completion at another time, so it is important to be prepared to fill out the form in its entirety and then submit once completed. It is recommended that you download this nomination form so you can easily copy and paste your answers into this online form.

If you prefer to fill out the form on paper you can download and print the Word document at the button below.

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Award Category (please check one category per nomination form):

NOMINEE INFORMATION

Name of Nominee: (required)

Company/Title:

Address:

Day Phone: (required)

Evening Phone: (required)

Email:

NOMINATOR INFORMATION

Name of Nominator: (required)

Organization/Title:

Address:

Contact Person (if other than the nominator):

Day Phone: (required)

Evening Phone:

Email: (required)

1) Candidate's biographical information: (required)

2) How has the nominee inspired and motivated the community in the practice and philosophy of philanthropy? (required)

3) How has this effort impacted and improved the quality of life in Eastern Iowa? (required)

When nominating individuals, please answer the following: (not applicable for organization nominees)

4) Nominee's current and past affiliation(s) with non-profit organizations: (Please note participation level, dates of service.)

5) Please list memberships in civic clubs and organizations: (required)

You may attach additional supporting documents here.