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Young Citizen of the Year Nomination Form

Nominee Name
First Name*
Last Name*
Address1*
This year Wall Township will be naming a Young Citizen of the Year. The award recognizes an individual with outstanding leadership and citizenship in the community.
Address2
City*
State*
Zip*
Age
*The information in this section is considered personal information, and is therefore deemed confidential for the purpose of P.L. 1963, c. 73 (C.47:1A-1 et seq.) and P.L. 2001, c. 404 (C.47:1A-5 et al.).
Email address of person submitting nomination*
*The information in this section is considered personal information, and is therefore deemed confidential for the purpose of P.L. 1963, c. 73 (C.47:1A-1 et seq.) and P.L. 2001, c. 404 (C.47:1A-5 et al.).
Phone number of person submitting nomination*
*The information in this section is considered personal information, and is therefore deemed confidential for the purpose of P.L. 1963, c. 73 (C.47:1A-1 et seq.) and P.L. 2001, c. 404 (C.47:1A-5 et al.).
Extracurricular Activities
Please list all extracurricular activities participated in by nominee.
Volunteer Experience
Please list all volunteer hours and experiences participated in by nominee.
Please explain in detail why you believe this young adult should be awarded the Wall Township Young Citizen of the Year Award for 2023
Date*
Signature*

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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