Anchin :: Application Form - Outstanding Public Service

Application Form
Outstanding Public Service

To be considered for the Outstanding Public Service award, entrants must complete the nomination form below. All submitted information will be subject to independent verification.

Company Name:		Name of Primary Contact:

Phone:		Title:

Fax:		Email (required):

Year Company Founded:		Website:

Number of Employees:		President/CEO:

Address:		City:

State:		Zip Code:

Award Criteria

Nominees will be judged on the information provided below. Responses to each question should be limited to 750 words or less.

Annual Revenue 2009:

Total Amount of Charitable Donations (in dollars):

List any projects or clients the firm has taken on without charge:

Describe any mentoring programs, scholarships, and educational outreach the firm sponsors:

Describe any partnerships or projects the firm has with not-for-profit organizations or other philanthropic enterprises:

List any leadership positions that the company’s executives staff hold in industry, civic, or charitable organizations:

Describe any other programs or activities undertaken by the firm that have a significant impact on the community or that demonstrate a commitment to public service:

To the best of my knowledge, all of the data and information contained on this application is accurate.

Name:		Title: