Local Chapter Community Service Award Nomination Form

Candidates for this award must meet the following:

An APHON Chapter in good standing.
Has not received the award previously within the last 3 years.
Have submitted all required paperwork to APHON headquarters.
100% of local chapter members are national members.
The chapter must have created and delivered an original community project that has benefited the public.

Completed nominations must be submitted by June 30.

Local Chapter Community Service Award

Chapter Name(Required)

Chapter President

First Last

Chapter Vice President

First Last

Chapter Secretary

First Last

Chapter Treasurer

First Last

Number of chapter members

Nominator Contact Information

Name(Required)

First Last

APHON Member ID

Nominator Email(Required)

Nominator Institution

Describe in detail the community service activity including development of idea and the planning and implementation of the project.(Required)

How many local chapter members were involved with the project?(Required)

How did the community benefit from the project?(Required)

Are there plans to continue the project?(Required)

Upload supporting documents, if applicable

Max. file size: 160 MB.

Upload any exciting chapter photos. By uploading photos, you give APHON permission to use the media for announcements of awards (member connections, emails and social media.)

Drop files here or

Max. file size: 160 MB.

Name

This field is for validation purposes and should be left unchanged.

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