Youth Services Bureau of Huntington County

Steven Bailey Memorial Award

Steven Bailey Nomination Form

Please fill out print and mail this form to:

                                                                 Youth Services Bureau of Huntington County

                                                                 Attn: Steven Bailey Memorial Award

                                                                 1344 Maple Dr.

                                                                 Huntington, IN 56750

 

Youth Services Bureau of Huntington County

Steven L. Bailey Memorial Award

Nomination Form

 

Nominee:                                                                                         Phone:                                         

 

Address:                                                                                                                                             

 

Nominated by:                                                                                 Phone:                                         

 

Address:                                                                                                                                             

 

List the activities the nominee is involved in that enable him or her to impact Huntington County’s youth:  (Feel free to use additional space if desired)

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

In what ways has the nominee been instrumental in reaching the youth of Huntington County?

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

Please describe the impact that the nominee has had on Huntington County youth.

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

Number of years working with youth.                               

 

Please return to:               Youth Services Bureau

                                       1344 Maple Drive

                                       Huntington, IN  46750

 

E-mail application to: ysbadm@choiceonemail.com

Nominations are due December 2, 2008.  Recipient will be recognized at the YSB’s Annual Dinner in January 29, 2009.