Jefferson Awards Nomination Form

The WCHS-TV8/WVAH Fox 11 Annual Jefferson Awards for Outstanding Citizens seeks to recognize and reward local citizens for outstanding public service. The Awards will honor deserving area citizens, and each of five winners selected will receive the Jefferson Medal, will be honored at a Spring luncheon and be profiled on WCHS-TV's Eyewitness News at Noon. One winner will represent the area in the national awards in Washington D.C.

There is no age limit for nominations.

Name of Individual Nominated:

Their address:

Their city, state, Zip Code:

Their phone number:
(This allows us to contact the nominee.)

Their place of employment:

Job title(s) and/or volunteer capacity or field for which you feel this person should be honored:



Please describe the activities and contributions to the community which make you think of this person as one deserving of recognition. Please tell us about the number of hours your nominee volunteers per month, what organizations, whether it is outside of their place of work, and a direct description of what the individual's efforts mean to the community or region. Please be as brief as possible. You may use this paper or attach a separate sheet. Limit your nomination to 200 words on one side.





Your name:

Your Address:

Your City:

Your State:

Your Zip Code:

Your phone number:
(This allows us to contact nominator, if necessary.)

Another person who would verify the accuracy of the nomination information.

Name:

Address:

City:

State:

Zip Code:

Phone Number:
(This allows us to verify information, if necessary.)


Send this nomination to:
    Jefferson Awards for Outstanding Citizens
    Attn: Jo Corey
    WCHS-TV8/WVAH Fox11
    1301 Piedmont Rd.
    Charleston, WV 25301