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2012 - 2013 Nomination Form Adams County Mayors and Commissioners Youth Award The Adams County Mayors and Commissioners Youth Award (ACMCYA) is an award that recognizes teenagers between the ages of 13 and 19 who have overcome personal adversity and created positive change in their lives. The award program provides business, community, and civic leaders an opportunity to actively demonstrate their belief in and support for the young people in our communities. Teens need recognition and support. In these days when much of the press about teenagers is negative, the Adams County Mayors and Commissioners Youth Award focuses on teenagers who have triumphed over great odds and serve as inspirations and role models. If you know young people who would be good candidates for the Adams County Mayors and Commissioners Youth Award, please help us identify them by completing the attached nomination form. Mission of the ACMCYA To identify and recognize teenagers who have overcome obstacles and risen to challenges life has presented. The ACMCYA is unique because it recognizes youth who have overcome difficult situations in their lives by making positive changes and by exhibiting strength and determination in the face of adversity. The young people we recognize have had a positive influence on themselves and those around them and often have not had any official recognition. The Adams County Mayors and Commission Youth Award is a 2-tiered program that honors nominees at a local and county level. Typically, all nominees are recognized at the local level, and then a screening process takes place to determine which nominees will be honored at the county level. This award is unique because it encompasses all youth: youth who have not finished school, youth in traditional classroom settings, youth in group homes, youth in alternative schools, and emancipated youth. In describing your nominee, please be specific as to why you think your nominee should receive this award. As you fill out these forms, keep in mind that the more information you include, the easier it will be for the screening committee to recognize what makes these young people so special. We realize that some of the information may be sensitive. Please indicate if any of the information needs to be kept confidential. ---PAGE BREAK--- 2012-2013 Nomination Form Adams County Mayors and Commissioners Youth Award Details 1. Nomination forms must be received no later than February 8, 2013. Nominations will not be accepted after this date. 2. Please indicate if any part of this information should be kept confidential. 3. Nominee’s age as of December 31, 2012 must be between 13 and 19. 4. All nomination forms must be signed and mailed to your Coordinator. No forms will be accepted without signatures. We will accept typed signatures on electronic copies Step 1. Tell us about your nominee. (Please enter information in the fields below and fill the form out completely.) PLEASE TYPE OR PRINT LEGIBLY. Gender: Male Female Name of Nominee: Nominee’s Phone: Zip If student, school Grade Level (if applicable):___________ County in which School is located: Email: Nominee’s age as of 12/31/12: Date of Nominator’s Nominator’s Zip Nominator’s Relationship to Additional Contact Phone: City: Zip Relationship to Nominee: To the best of my knowledge, all the information provided in this application is true and reflects the nominee accurately. I have made note of specific information about the nominee that needs to be kept confidential. Signature of Nominator Date Signature of Nominee Date Complete entire nomination form, sign and mail or email to: [EMAIL REDACTED] Fax: [PHONE REDACTED] Mail: Thornton Community Center ATTN: Jenny Dowdell 2211 Eppinger Boulevard Thornton, CO 80229 ---PAGE BREAK--- Step 2. Tell us why your nominee deserves this award. Please be as specific as you can and use additional sheets if necessary. Pertinent supplementary material may be included. (Please fill this form out completely by typing or printing legibly in the form fields below.) Nominations with very brief or incomplete information may not be given as much consideration as thorough nominations. Provide as much information and as many specific examples as possible. (Examples might include: overcoming physical, emotional, or other challenges; providing financial or emotional support to family and friends; care of sick or elderly sibling, parent, or friend; providing positive leadership and role modeling for other youth; positive behavioral changes; and community involvement.) 1. Describe the personal adversity, difficult environment, or limitations your nominee has overcome. 2. What were the key factors that helped your nominee turn his or her adversity to advantage? 3. In what ways has your nominee benefited himself/herself or other youth, their family, or their community? 4. Why do you feel your nominee should receive this award?