To nominate a volunteer for the Exceptional Community Volunteer Award, complete the form below and submit by Friday, December 1, 2017. The award will be presented in April 2018 at the United Way of Central New York’s Achieve-ment Celebration. This form may be copied and it can be completed by anyone who is directly involved with the volunteer and their work. Please complete and submit by e-mail to or fax it to 315-428-2227, Attention: Volunteer Coordinator.

Nominee's Name
Nominee's Email Address
Nominee's Address
Nominee's Phone Number
Organization Name
Organization's Mission Statement
Organization Contact
Organization Address
Organization's Telephone Number
Organization's Fax Number
Contact Email Address
Describe how the volunteer supports your agency's mission: ?
Please tell us how your nominee's service to the agency supports your agency's mission statement as listed above.
Describe how the volunteer assists your agency: ?
Examples: Skills/talents offered by the volunteer, the volunteer's versatility, increased effectiveness of a program, service or project.
Please describe the level of commitment shown by the volunteer: ?
Examples: A problem the volunteer has solved. Personal sacrifices made. Advocacy efforts.
Please describe the volunteer’s attitude: ?
Examples: How the volunteer works with other volunteers. How the volunteer works with staff and/or promoting teamwork throughout volunteering.
Please describe the volunteer’s achievements. ?
Examples: Meeting personal goals. Meeting agency goals.