Individual Nomination Form

Once your nomination has been submitted you will not be able to access the nomination form again. We encourage you to draft your nomination in a Word document and then copy and paste into our form so that you have the time to make changes before you submit.

Nominator Name

First Name

Last Name

Nominator Email

Nominator Employer

Nominee Name

First Name

Last Name

Nominee Email

Nominee Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nominee's Race/Ethnicity

If unsure, list "Unknown"

Nominee Employer

Nomination Category

Age Range of Nominee

Degrees Earned

Have they pursued additional training in their field? Select all that apply.

None

G.E.D

High School Diploma

Associate's

Bachelor's

Master's

Doctorate

Other

How does the nominee’s professional work experience qualify them for the category you are nominating them for?

Please include their current title, company, any work-related accomplishments, and past positions or work experience.

What is the nominee’s volunteer experience?

Please list all volunteer positions held, what organization they volunteered for, and describe the impact made through volunteering in their nomination category.

How has your nominee impacted the Tulsa Community?

Can you share an example of when the nominee has shown courage in the face of adversity?

Has the nominee previously received public recognition or awards? Have they been recognized in the media, received an award from the community, been recognized at work or by their peers?

Add website links if available