PARTNERSHIP PRIZE NOMINATION FORM

NOMINATION DEADLINE: October 29, 2014

Q.1
Category for which the partnership is being nominated *

Q.2
Names of organizations involved in the partnership: *

Q.3
Briefly explain why these particular organizations came together for the partnership: *

Q.4
Description of the partnership’s objectives, including specific challenges the partnership was designed to address: *

Q.5
Description of particular program or approach used to address partnership objectives: *

Q.6
Time frame of the partnership) New within the last 12 months, completed within the last 12 months, if ongoing, provide date of inception): *

Q.7
Measurable results obtained through the partnership: *

Q.8
Provide copies of testimonials, media coverage, and/or other evidence of the partnership’s impact on the community or environment: *

Contact information for senior executive from organization 1 in the partnership:

Q.9
Organization Name

Q.10
County

Q.11
Name


Q.12
Title *

Q.13
Phone # *

Q.14
Email *

Contact information for senior executive from organization 2 in the partnership:

Q.15
Organization Name

Q.16
County

Q.17
Name


Q.18
Title *

Q.19
Phone # *

Q.20
Email *