NORTH CAROLINA JAYCEES
2008 Outstanding Senior Citizen Nomination Form
The North Carolina Jaycees will honor five of our state’s most outstanding Senior Citizens. The purpose of this program is to recognize Senior Citizens who are over the age of sixty (60) and who have shown exemplary qualities of leadership during their lifetime. Each nominee will be judged by the following criteria: - Contributions to the Community (50%) - Evidence of Leadership Ability (25%) - Evidence of Personal Progress (25%) Nominees selected as the community’s Outstanding Senior Citizen will receive local recognition and will become a nominee in the state competition. This form serves as the official entry form for local and state competition. Nominee Qualifications 1. Be over the age of sixty (60). 2. Demonstrated exemplary qualities of leadership during their lifetime. Requirements for Nomination 1. Nominee must complete information and questions on this form. (Additional sheets may be attached). Use black ink or type. 2. Nominee must sign the form on page 2. 3. Nomination form and attachments must be submitted to the local Jaycee chapter by . Chapter mailing address: Background Information Nominee Name: Address: City/State/Zip: Home Phone: Occupation: Business Address: Marital Status: Children (Name/Ages): Schools Attended (Degrees/Honors/Etc.): Military Service (Branch/Service Dates/Rank): Civic, Fraternal, Religious Organizations/Affiliations: Spouse's Name: Business Phone:
Birthdate:
Age:
Questions Describe or outline the nominee’s contributions to their community. Describe or give evidence of the nominee's leadership ability.
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Describe or give evidence of personal and/or business progress.
Nominee Signature I certify that, to the best of my knowledge and belief, the statements given truly represent my background and activities. I give permission for the facts to be used in publication. Signature of Nominee _________________________
LOCAL CHAIRMAN ONLY Deadline for receipt of entries to state competition is March 25, 2008. Send 5 copies of the nomination form and attachments and the $5.00 entry fee to NC Jaycees, P.O. Box 1323, Asheboro, NC 27204-1323. I certify that the above name is of the duly selected nominee of the Carolina Jaycees State Competition. Chapter President: Address: Phone: Signature of Chapter President ________________________ Will Nominee be available to attend the State Awards Banquet on April 12, 2008? Yes No Jaycees and is our official entry in the North
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