Citizen of the Year Award Nomination Form

Name of Nominee * Required
First Last
Nominee Address (must be a Fairfax resident) * Required
Street Address Address Line 2 City ZIP / Postal Code

Must be a Fairfax resident.
Nominee Phone * Required
Nominee Email * Required
Nominator Name * Required
First Last
Nominator Address * Required
Street Address Address Line 2 City ZIP / Postal Code
Nominator Phone * Required
Nominator Email * Required
Enter Email Confirm Email
Community Constributions
The committee may not know the candidate who is being nominated, so please be descriptive in your responses.
1. What contributions has this individual made to the community that are beyond the scope of normal civic responsibilities? * Required
2. What impact on the community did this individual’s activities make? How has this person made a difference? * Required
3. Discuss the time and energy this person has devoted to community projects/efforts? * Required
4. To what extent has this individual’s efforts been previously recognized by the community? * Required

Community Constributions