Nomination Form

Citizen of the Year Nomination

The Citizen Recognition Program was created by Citizen Recognition Award Committee of Wentzville to acknowledge outstanding individuals and groups that make a significant contribution, a positive impact, or improving the quality of life for citizens in the community. Nominations are open year-round. To nominate someone, please complete the nominating form.

Nomination Form

Nominee's Name

First Last

Nominee's Address

Street Address Address Line 2 City State ZIP Code

Nominee's Phone Number

Nominee's Email

Does Nominee reside in the city limits of Wentzville?

Yes

What organizations, committees or clubs does this individual belong to?

Is this individual actively committed to making contributions to the community? If so, please describe how.

Describe how this person has helped others before himself/herself.

Description of an accomplishment or action:

Why do you believe this award is merited by this individual?

Was this accomplishment or action work-related, volunteerism or for-profit?

Nominator's name

First Last

Nominator's Address

Street Address Address Line 2 City State ZIP Code

Nominator's Phone Number

Nominator's Email

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