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YMCA BLACK ACHIEVERS
NOMINEE INFORMATION

Being a Black Achiever is more than just recognition: each award represents a commitment made by every Achiever and every sponsoring company. Adult Achievers serve as volunteer counselors, tutors, friends and advisors to the Youth Black Achievers. To facilitate the interaction between Adult and Youth Achievers, we recommend the following criteria when considering the nomination of each individual:

* Connected with your company for at least two years
* Succeeding in a key area of responsibility, especially those without public recognition he or she deserves
* Willing to volunteer at least one year of service to the program
* Engaged in community service or company representation

Please complete the form below and return by MARCH 1, 2005.

NOMINATORS

Nominator

Email

Company Name

Company Contact Info
(if different than Gift Opportunities Form)

NOMINEES

Nominee Name

Gender

Male Female

Address

City

State

Zip Code

Email

Phone

Your Neighborhood Newspaper

Nominees, please send a current personal biography. On one to three pages, briefly describe your educational background, professional responsibilities and positions, involvement in community, YMCA, church and other organizations.

I consent to be photographed by the YMCA of Greater Cincinnati and authorize the use of photographs, for use either alone or with other images, for advertising, publicity, commercial or other business purposes.

Please type your name for consent.

Please make sure every form field is filled in for accurate application submission.