CAPITAL DISTRICT KIWANIS INTERNATIONAL
TEENAGER OF THE YEAR - 2008
Form 1. STATEMENT OF NOMINEE
Name___________________________________________________________________
Area code and telephone________________________ e-mail______________________
Mailing address___________________________________________________________
City, state, zip____________________________________________________________
Birth date__________________________ School grade level______________________
Parents/guardians names____________________________________________________
Sisters/brothers and ages____________________________________________________
________________________________________________________________________
Name of school and city____________________________________________________
School activities/clubs, listing offices held/year__________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
School honors/awards or special achievements__________________________________
________________________________________________________________________________________________________________________________________________
Other activities such as, scouting, church, youth group, offices held/year______________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Volunteer service activities, listing organization/year_____________________________
________________________________________________________________________________________________________________________________________________
What motivates you to volunteer your time and abilities?__________________________
________________________________________________________________________________________________________________________________________________How
has volunteering for service in your school or charity work affected you?
________________________________________________________________________________________________________________________________________________
What are your future aspirations (college/career)?________________________________
________________________________________________________________________
Who is your role model, and why?____________________________________________
________________________________________________________________________________________________________________________________________________What/who has had the most influence on your life and why?
________________________________________________________________________________________________________________________________________________
Special interests, hobbies___________________________________________________
Please describe any obstacles you may have had to overcome in your quest to develop as
a responsible individual____________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
If you were “ruler of the world” for one day, what one thing would you do to improve it?
________________________________________________________________________________________________________________________________________________
DATE____________ SIGNATURE _____________________________
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To be filled in by Kiwanis Contact
Sponsoring Kiwanis Club__________________________________ Division_________ Contact________________________________ Area Code/Telephone_______________
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CAPITAL DISTRICT
KIWANIS INTERNATIONAL
Form 2. PERMISSION TO USE NAME AND PHOTOGRAPH
I give permission to the Capital District of Kiwanis International to use my name, photograph and information in press releases, newsletters or other publicity.
SIGNATURE______________________________
(If under 18 years of age, must also include signature
of parent/guardian)
PARENT
SIGNATURE_______________________________
Area code and telephone_______________________
Date______________
CAPITAL DISTRICT KIWANIS INTERNATIONAL
TEENAGER OF THE YEAR NOMINATION
Local clubs of Kiwanis International are seeking nominations for Teenager of the Year. The purpose of this award is to give recognition to deserving teenagers for their academic achievements, citizenship, service to their school and community, growth and responsibility in his/her family unit, character and leadership performance. If nominee continues through competition process on club, division and district levels, the finalist will win $1,000 cash and trip with their parents/guardians to the Kiwanis District Convention August 15th 2008 at the Richmond Marriott.
Form 3. RECOMMENDATION OF SCHOOL PRINCIPAL OR TEACHER
Name of Nominee ________________________________________________________
School__________________________________________________________________
Name of Person making recommendation______________________________________
Title/Position __________________________Area code/telephone__________________
How long have you known this student? _______________________________________
Accumulated grade point average______________ Standing in class: ______ of_______
Achievements: academic__________________________________________________
sports______________________________ clubs_______________________________
Other honors/awards, all years_______________________________________________
________________________________________________________________________________________________________________________________________________
What leadership role(s) has this student assumed, and what effect has this had on him/her, their peers, or success of the class/activity?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What special talents or abilities does this nominee possess and how is he/she using or developing them?
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please describe this nominee’s relationships with: (i.e., respectful, is a leader)
peers______________________________________________________________
authority___________________________________________________________
family unit_________________________________________________________
Comments relative to student’s personality and character, and/or any obstacles this student had to overcome that would merit recognition as Teenager of the Year.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
DATE__________________ SIGNATURE___________________________
PLEASE RETURN DIRECTLY TO KIWANIS CONTACT:
____________________________________________
____________________________________________
CAPITAL DISTRICT KIWANIS INTERNATIONAL
TEENAGER OF THE YEAR NOMINATION
Local clubs of Kiwanis International are seeking nominations for Teenager of the Year. The purpose of this award is to give recognition to deserving teenagers for their academic achievements, citizenship, service to their school and community, growth and responsibility in his/her family unit, character and leadership performance. If nominee continues through competition process on club, division and district levels, the finalist will win $1,000 cash and trip with their parents/guardians to the Kiwanis District Convention on August 15th 2008 at the Richmond Marriott.
Form 4. RECOMMENDATION OF ADULT COMMUNITY LEADER,
CLERGY OR NEIGHBOR
Name of Nominee_______________________________________________________
Name of person making recommendation_____________________________________
Title/Position_________________________ Area code/telephone___________________
How long have you known the nominee?______________________________________
Is there any characteristic, or situation, that sets this nominee apart from other teenagers,
what?___________________________________________________________________________________________________________________________________________________________________________________________________________________
What leadership roles or areas of responsibility has this person assumed and how has it affected him/her, his/her peers, or the community?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What special talents, skills or abilities does this nominee possess and how are they using or developing them?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please describe this nominee’s relationship with: (i.e., respectful, is a leader)
you_________________________________________________________________
peers________________________________________________________________
authority_____________________________________________________________
famiy unit____________________________________________________________
Comments relative to nominee’s personality and character, or obstacles they may have had to overcome, that would merit recognition as Teenager of the Year
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
DATE_________________ SIGNATURE_____________________________
PLEASE RETURN DIRECTLY TO KIWANIS CONTACT:
____________________________________________
____________________________________________
____________________________________________
CAPITAL DISTRICT KIWANIS INTERNATIONAL
TEENAGER OF THE YEAR NOMINATION
Local clubs of Kiwanis International are seeking nominations for Teenager of the Year. The purpose of this award is to give recognition to deserving teenagers for their academic achievements, citizenship, service to their school and community, growth and responsibility in his/her family unit, charger and leadership performance. If nominee continues through competition process on club, division and district levels, the finalist will win $1,000 cash and a trip with their parents/guardians to the Kiwanis District Convention on August 15th 2008 at the Richmond Marriott.
Form 5. RECOMMENDATION OF COMMUNITY ORGANIZATION, OR EMPLOYER
Name of Nominee_____________________________________________________
Name of person making this recommendation________________________________
Title/Position_______________________ Area code/telephone____________________
How long have you known, or worked with this nominee? ________________________
Is there any characteristic, or situation, that sets this nominee apart from other teenagers, what? __________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please describe the volunteer service or working relationship with the nominee, i.e., employed as, does volunteer paper work, candy stripper.
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please describe the nominee’s dependability, assuming responsibility and maturity on the job/service.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please describe this nominee’s relationships with: (i.e., respectful, is a leader)
peers/co-workers________________________________________________________
authority ______________________________________________________________
customers/public________________________________________________________
Comments relative to nominee’s personality and/or character, or overcoming any obstacles that would merit recognition as Teenager of the Year.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
DATE________________ SIGNATURE _____________________________
PLEASE RETURN DIRECTLY TO KIWANIS CONTACT:
____________________________________________
____________________________________________
____________________________________________
CAPITAL DISTRICT KIWANIS INTERNATIONAL
TEENAGER OF THE YEAR NOMINATION
Form 6. SUBMISSION OF NOMINATION BY LT. GOVERNOR
Lt. Governor Name___________________________________________ Division _____
Address_________________________________________________________________
Area Code/Telephone___________________________ e-mail_____________________
Division Teenager of the Year Chair__________________________________________
Name of Teenager of the Year Nominee_______________________________________
How many nominations were submitted by clubs in your division?__________________
What attributes(s) set this nominee apart from the rest of the nominees you considered?
What did you do to recognize your Division Teenager of the Year?__________________
Please enclose copy of any publicity/media releases regarding this nominee’s selection as
Club and/or Division Teenager of the Year.
Has this student been advised that his/her nomination is being considered for District
Teenager of the Year competition? _____Yes ____No
DATE__________________
SIGNATURE________________________________
Checklist
1. ___ Statement of nominee
2. ___ Permission form to use name and photograph
3. ___ Recommendation of teacher or principal
4. ___ Recommendation of adult neighbor, clergy or community leader
5. ___ Recommendation of community/charity organization, or employer
6. ___ Statement of Lt. Governor, with copies of publicity if any
7. ___ Photograph of nominee
NOMINATIONS MUST BE POSTMARKED BY JUNE 1, 2008.