2015 richmond history makers - nomination form

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Today’s events serve as tomorrow’s history, yet sometimes even the most powerful success stories and hard-working individuals go unnoticed. The Valentine launched the Richmond History Makers program to recognize everyday citizens and outstanding organizations making significant contributions to the greater Richmond region. Public nominations will be accepted for those who are benefiting our community by mentoring best practices, leading successful initiatives and contributing positively through innovative methods. Honorees will be selected among five categories of distinction, and each will be recognized at the 2015 Richmond History Makers Celebration, October 20, 2015 at the Valentine. Thank your for your help in identifying candidates and organizations that are today’s Richmond History Makers. 2015 NOMINATION FORM Deadline: June 30, 2015 YOUR INFORMATION NOMINEE INFORMATION PLEASE TYPE OR PRINT _______________________________________________________________________________________________________________ NAME (required) _______________________________________________________________________________________________________________ TELEPHONE (required) EMAIL ADDRESS (required) _______________________________________________________________________________________________________________ HOW DID YOU HEAR ABOUT THE RICHMOND HISTORY MAKERS? _______________________________________________________________________________________________________________ NOMINEE NAME (required) _______________________________________________________________________________________________________________ ORGANIZATION NAME (if applicable) _______________________________________________________________________________________________________________ ADDRESS (required) _______________________________________________________________________________________________________________ CITY (required) STATE (required) ZIP _______________________________________________________________________________________________________________ TELEPHONE (required) _______________________________________________________________________________________________________________ EMAIL (required) WEBSITE ADDRESS (if applicable) _______________________________________________________________________________________________________________ NUMBER OF YEARS NOMINEE HAS BEEN IN THE RICHMOND REGION GENDER AGE ETHNIC BACKGROUND PLEASE CONTINUE TO THE NEXT PAGE

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Page 1: 2015 Richmond History Makers - Nomination Form

Today’s events serve as tomorrow’s history, yet sometimes even the most powerful success stories and hard-working individuals go unnoticed. The Valentine launched the Richmond History Makers program to recognize everyday citizens and outstanding organizations making signifi cant contributions to the greater Richmond region. Public nominations will be accepted for those who are benefi ting our community by mentoring best practices, leading successful initiatives and contributing positively through innovative methods.

Honorees will be selected among fi ve categoriesof distinction, and each will be recognized at the 2015 Richmond History Makers Celebration, October 20, 2015at the Valentine.

Thank your for your help in identifying candidates and organizations that are today’s Richmond History Makers.

2015 NOMINATION FORM Deadline: June 30, 2015

YOUR INFORMATION

NOMINEE INFORMATION

PLEASE TYPE OR PRINT

_______________________________________________________________________________________________________________NAME (required)

_______________________________________________________________________________________________________________TELEPHONE (required) EMAIL ADDRESS (required)

_______________________________________________________________________________________________________________HOW DID YOU HEAR ABOUT THE RICHMOND HISTORY MAKERS?

_______________________________________________________________________________________________________________NOMINEE NAME (required)

_______________________________________________________________________________________________________________ORGANIZATION NAME (if applicable)

_______________________________________________________________________________________________________________ADDRESS (required)

_______________________________________________________________________________________________________________CITY (required) STATE (required) ZIP

_______________________________________________________________________________________________________________TELEPHONE (required)

_______________________________________________________________________________________________________________EMAIL (required) WEBSITE ADDRESS (if applicable)

_______________________________________________________________________________________________________________NUMBER OF YEARS NOMINEE HAS BEEN IN THE RICHMOND REGION GENDER AGE ETHNIC BACKGROUND

PLEASE CONTINUE TO THE NEXT PAGE

Page 2: 2015 Richmond History Makers - Nomination Form

The nominee is making a difference in this area of the Richmond region:(Check all that apply.)

Amelia

Charles City

Chesterfi eld

Colonial Heights

Dinwiddie

Goochland

Hanover

Henrico

Hopewell

New Kent

Petersburg

Powhatan

Prince George

Richmond City

I nominate _____________________________________________in the following category* (check ONE):

Creating Quality Educational OpportunitiesNominee will have enhanced educational opportunities for citizens, improved academic achievement, or ensured a safe, constructive learning environment.2014 Honoree: Ms. Dorothy S. Gallimore

Demonstrating Innovative SolutionsNominee will have demonstrated innovation and vision in making the Richmond region a better place to live, work, or visit.2014 Honoree: Richmond Cycling Corps

Encouraging Regional CollaborationNominee will have endeavored to bring together different entities to develop solutions that improve effi ciency and effectiveness of programs across jurisdictions.2014 Honoree: CARITAS

Improving Social JusticeNominee will have shown a commitment to promoting diversity, access and opportunity for all.2014 Honoree: Clovia Lawrence, Founder of Rolling for Freedom

Promoting Stronger CommunitiesNominee will have worked to address problems, develop initiatives, or make lastingimprovements that result in stronger, more stable communities.2014 Honoree: Robert (Bob) S. Argabright II

*The Selection Committee reserves the right to change a nominee’s category.

NOMINATION REQUIREMENTS

DEADLINE: JUNE 30, 2015

For additional examples of past honorees, visit RichmondHistoryMakers.com

Nominee must be living and reside in one of the localities at right. Nominee may not be an employee or a Trustee of the Valentine. Nominee may be an individual, organization, company, coalition or group.

Nominees are considered based entirely on what is submitted in support of their nomination. Please include clear evidence of impact.

Please answer the following questions. (500 word limit for each question)

• What makes the nominee’s work unique, innovative, or otherwise worthy of recognition?• How has the community changed because of the nominee’s efforts?

We are unable to accept DVDs, CDs, videos and other electronic materials. Attach photos, letters of support/ recommendation, testimonials, media coverage (newspaper, blog, etc.). Additional attachments are limited to a total of two pages.

Nominations will be accepted until 5 p.m. on June 30, 2015.

Please fax or mail the completed form.

FAX (804) 643-3510 MAIL Richmond History Makers Nominationc/o The Valentine1015 East Clay StreetRichmond, VA 23219

Or nominate online at RichmondHistoryMakers.com

An independent Selection Committee oversees the nominating and judging process, and honorees will be notifi ed by August 1, 2015. Residency in the greater Richmond region and an agreement to publicity is necessary for eligibility. Questions may be directed to Domenick Casuccio at (804) 649-0711 ext. 322 or [email protected]