Portraits of Success - Nomination Form

KSEE 24, Central Valley's News Station and Companies You Count On are proud to sponsor Portraits of Success in celebration of our cultural diversity. In September we will bring you the Hispanic American Portraits of Success awards. These awards recognize the dedication and personal sacrifice of outstanding individuals in our community. KSEE 24, Gottschalks and Warner Company are proud to honor these unsung heroes.

KSEE 24 is now taking nominations. The awards are based on an individual having contributed a significant amount of time, expertise and special talents to help better their community.

For more information please contact Kenia Chavez at (559) 454-2480 or kenia@ksee.com.

1.Nominee's Information

Nominee

Address

City

Zip

Home Phone

Work Phone

Fax

Workplace of Nominee

Supervisor

Current Position of Nominee

2.Nominator's Information

Nominated By

Nominator's Address

City

Zip

Home Phone

Work Phone

Nominator's Fax

Nominator's Email

3.1. Explain why this individual should receive the Portraits of Success Award.

4.2. Please provide specific examples of accomplishments demonstrating dedication and personal sacrifice: a) In his/her profession:

5.b) In his/her community

6.c) In his/her dedication to patients, co-workers, and family

7.3. Describe how this nominee serves as an inspiration and role model.

8.4. Please provide examples of past recognition, honors, awards, etc. received by the nominee.

9.5. Please provide additional facts the judges should know that are relevant to the nomination.

10.6. In your estimation, what single word best describes this nominee.

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