Form Preview Alumni Business Community Impact Award Application Local Business Community Impact Nomination Criteria Award recipients will have demonstrated an impact on the community through their commitment to philanthropy, service, and volunteerism, or employing local high school graduates. This award recognizes a local business owner(s) with their business located within Lycoming County, who graduated from the Montoursville Area School District High School no less than twenty (20) years prior to the nomination year. Nominator: Please provide the following: Submission of this Nomination Form Letter of support/overview/or summary describing specifically how this nominee has demonstrated impact on the community through their business success, their commitment to philanthropy, community service and volunteerism, or on employing local high school graduates. Weblinks to publications, accomplishments or any other information that demonstrates the nominee’s qualifications for distinction. Photo of the nominee, if possible (not required at this time) Nominee Information Graduation Year: Nominee (Owner) Name: Business Name: Business Phone: Home Phone: Business E-mail: Nominator's (Your) Information First Name: Last Name: Relationship to Nominee: Address: Home Phone: Work Phone: Email: Narrative, if needed (maximum 1,000 characters) Is the Nominee aware of this nomination? Yes No I certify, to the best of my knowledge, that the information I have provided is accurate. Signature of Nominator: Date: By signing my name above, I am electronically signing this application. Reminder All materials must be received no later than September 1st to be considered. MASD Foundation Board members, Selection Committee members and their immediate family members are not eligible for any of these awards. MASD Foundation PO Box 235 Montoursville, PA 17754 Click on the Submit button below to send to the Foundation. Upload a letter of support, overview or summary here: Drop a file here or click to upload Choose File Maximum upload size: 25.6MB Submit
