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2. Name of Volunteer*
4. Volunteer's Email Address
6. Volunteer's Phone Number
8. Address1
10. City
11. State
12. Zip
16. Type of Volunteer

    1. Organization
    2. Group of Individuals
    3. Educator
    4. Youth or Young Adult (under age 25)

    1. Adult (ages 25-54)
    2. Adult (ages 55+)
    3. National Service Member (AmeriCorps State, AmeriCorps VISTA, AmeriCorps National, Learn and Serve, Senior Corps)
    4. Other (Please specify below)
18. Other
22. Service Category*

    Some nominations may fit into more than one service category. Please choose the category you feel best describes the volunteer's activities:

    1. Arts & Culture
    2. Education
    3. Environment
    4. Public Health
    5. Public Safety

    1. Recreation
    2. Social Services
    3. Special Events
    4. Other
24. If other, please describe*
26. How has this individual positively impacted the Town or the people of the Town?*
30. Your Name*
32. Address1*
34. City*
35. State*
36. Zip*
38. Email address*
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

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