Henjum Nomination Form - Senior Resource Council

Joe Henjum Accolades Nomination Form

The following form must be filled out completely and all questions answered in order for the nomination to be considered. Be specific and provide examples. Give as many details as possible as nominee will be considered only on the information provided.
Nominations must be received by Friday, May 15, 2021.

Please complete the steps below to submit your nomination.

Please select the category your nomination is for

Professional Volunteer Business/Nonprofit Organization

Your Name

Your Email Address

Your Telephone Number

Nominee's Name

Nominee's Email

Nominee's Phone Number

Is the nominee aware that they are being nominated?

Yes No

Has the majority of the work for this nomination been done in the Pikes Peak Region?

Yes No

Is the nominee being considered for work that is above and beyond their daily job or the mission of their business? If a nonprofit, is the organization being considered for work that resulted in significantly expanding their reach within their mission?

Yes No

What are the nominee’s major accomplishments in the senior industry?

What impact have these accomplishments had on the quality of life for seniors in the community? Be specific. Provide examples and statistics/numbers showing the impact if possible.

What else would you like the award selection committee to know?

719-260-0744

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Joe Henjum Accolades Nomination Form

Please complete the steps below to submit your nomination.

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