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dedicated volunteers
Nomination Form
Please answer all questions.
1. The name of the person you want to nominate (full name):
___________________________________________________________________
2. Has been volunteering from ______________________ to ______________________
in the capacity of _____________________________________
3. His / Her most significant contributions [Please explain briefly. Attach additional pages
if required]
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. Why do you think the AM35 Committee should award him / her [apart from his/her
contributions above]?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. How can we contact him / her?
HP: ____________________ Res: ____________________ Off: ___________________
Email: ___________________________________________________________________
6. Are you a volunteer / activist / board member / staff / jemaah of the mosque?
If not, please specify: ________________________________________
Last date of nomination: 6 December 2013
THANK YOU FOR NOMINATION