2. Nominee Information
4. Name*
5. Phone *
7. Street Address*
9. Neighborhood*
11. Email*
15. Your Information (Person Making Nomination)
17. Name*
18. Phone*
20. Neighborhood*
22. Email*
24. Your relationship to the person you are nominating*
26. Narative and Documentation. See Instructions Below*
    • Describe in 500 words or less why the nominee merits consideration for Derby’s Neighbor of the Year Award. Possible questions to address include: 
      • What specific actions has this nominee performed to make them a worthy nominee for this award?  (i.e., acts in service to individual neighbors, a neighborhood organization, an entire neighborhood, or the community as a whole) 
      • How have this nominee’s actions gone “over and above” the normal scope of citizen responsibilities? 
      • How has this person demonstrated a commitment to inclusive community?
      • How have neighbors, the neighborhood, the neighborhood organization, or the community benefited?
28. Attachments (optional)

    You may submit any additional relevant documentation (such as photographs, letters, pamphlets, project planning and expense data, articles, presentations).

30. File Upload (optional)
31. File Upload (optional)
32. File Upload (optional)
34. Questions?

    Judy Morris, HOA Liaison
    611 N. Mulberry, Suite 100, Derby, KS 67037 
    JudyMorris@derbyweb.com
    316.788.1519 ext. 1281

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36. 1. Receive an email copy of this form.
37. Email address

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38. Submit

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