Bell Awards Nomination Form

2018 WLKY-TV Bell Awards Nomination Form
(All questions must be answered in order for your nomination to be considered.)

Nominee Contact Information:

1. Name: (Required) *This question is required.

2. Street address: (Required) *This question is required.

3.

Street address: (Line 2 if needed)

4. City: (Required) *This question is required.

5. State: (Required) *This question is required.

6. Zip code: (Required) *This question is required.

7. Phone number:

Space Cell	Phone Number
Home	Phone Number
Work	Phone Number

8. Date of Birth:

9. Place of Employment:

Person or Organization Making the Nomination Contact Information:

10. Name: (Required) *This question is required.

11. Street address: (Required) *This question is required.

12. Street address: (Line 2 if needed)

13. City: (Required) *This question is required.

14. State: (Required) *This question is required.

15. Zip code: (Required) *This question is required.

16. Phone number:

Space Cell	Phone Number
Home	Phone Number
Work	Phone Number

17. Email address *This question is required.

References:
Please list three person (other than yourself) who know of the nominee's activities.

18. References: (Required) *This question is required.

Space Cell	Name	Phone Number
1 *This question is required	Name	Phone Number
2 *This question is required	Name	Phone Number
3 *This question is required	Name	Phone Number

19. Name of Person Making Nomination: (If different from above)

20. Organization of Person Making Nomination (if applicable)

In the following questions, do NOT mention the nominee's name.
Refer to them as "he" or "she" so the entries can be judged without bias.

The information you provide on the following questions will determine if your nominee is considered for a Bell Award. Therefore, it is very important that you provide as much detail as possible regarding your nominee’s volunteer efforts, current and past. There is a section provided below for attaching letters of support, articles or other documentation, and they will be included as part of the nomination.

Click NEXT below to continue answering questions about your nominee...

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