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"KATY Leadership Award"
Nomination Form

"The Best Mix" 101.3 KATY-FM encourages you to nominate an individual or group who make a positive impact in our local community.  The "KATY LEADERSHIP AWARD" will recognize those whose efforts have significantly improved the quality of life in our community.  We are looking for nominees who display selfless qualities - individuals or groups who volunteer, serve as role models or somebody who makes a contribution of any kind to make our community a better place to live. 
 

Your Name:
Phone Number:
Relationship to Nominee:
______________________________________________
Nominee:
Street Address:
City:
State:
Zip Code:
Phone:
______________________________________________

How has the nominee made a positive impact in our community or made a difference in the lives of others?

Is the nominee still involved in the solution or program?   Yes      No

If yes, how?

Has the nominee inspired others to actively get involved?

How long has the nominee worked on the program or solution?

What sacrifices has the nominee made in order to ensure the success of the program?

Privacy Notification
The information submitted is for the sole purpose of determining a KATY Leadership recipient. The information you provide will not be sold, distributed, or made public without prior consent.
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