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2. Select a Category*
   -- Select One --EmployeeVolunteerCommissionerPartnering Organization

   Categories:

   Employees – Nominee must be or have been employed with the Burlington Parks & Recreation Department for a minimum of 7 years, are in good standing with the Department and support the Department’s mission.  The nominee could have also provided outstanding service or contributed to a specific project.

   Volunteer – Nominee should have provided a minimum of 25 hours of service or contributed to a specific project that is not program related.

    Commissioner – Nominee should have a served a minimum of 2 terms.

    Partnering Organizations – Nominee must have made contributions that have been significant, substantial and longstanding.

4. Name*

   EXACTLY as it is to appear on the award plaque if they are selected

5. Mailing Address

   If known

7. Email Address

   If known

8. Phone Number
10. Length of Service*

    Number of YEARS this nominee has served.  Be specific.  It’s acceptable to estimate, but do not use terms like “many” or “countless”: 

14. Name of Person Submitting*
15. Business or Organization
17. Address*
19. City*
20. State*
21. Zip Code*
23. Phone Number*
24. Email Address*
28. Summary*

    Provide a very brief and specific statement describing the nominee’s history with the Burlington Parks & Recreation Department, and why they are worthy of being selected for our Hall of Fame.  This information may be used for announcements during the award ceremony or in media releases.

30. Community Needs*

    Describe how the nominee’s actions met or solved a real community need.  Include specific information about how the activities led to a long-term solution, and how the nominee made long-lasting positive and meaningful differences in the lives of people in the Burlington community through their services.

32. Connection Building*

    Provide examples of how the nominee demonstrated hands-on service to build connections between the community and those who might be isolated from it.  Explain how/if connections were made with groups beyond the agency for which the nominee worked.

34. Impact*

    List specific examples of the impact and benefits achieved as a result of the activities and efforts of this nominee.  Include how many and what types of people and groups were impacted.  What was the nominee’s level of involvement?  Was the amount of time spent significant?

36. Distinctive Achievements*

    Provide details about how their service was extraordinary and meaningful.  How did the nominee’s activities show innovative or unique approaches to addressing serious social challenges?

38. Upload a photo here.*
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

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