Gilmer County Citizen of the Year- A Lifetime Achievement Award
Nomination Form
Objective: To recognize an individual who has demonstrated a high level of service through their
professional, community and civic involvement in Gilmer County.
Criteria:
Generally considered as a well-rounded community leader both professionally and personally.
The candidate has an extended period of continued service and community involvement endeavors that enhance
the quality of life in the Gilmer County area.
The candidate should have a consistent “track record” for accomplishments, rather than being honored for a single
brief act of merit.
Guidelines:
Individual may not nominate self.
The Citizen of the Year does not have to be a member of the Gilmer County Chamber of Commerce.
It is most important that the nominee should have contributed to a minimum of two different organizations,
entities and/or programs.
The nominee must have lived in Gilmer County at least five years.
Nominee Information:
Name _______________________________________________________________________
Name of Business _______________________________________________________________
Address _______________________________________________________________________
City _________________________________ State _____________________ Zip Code_______
Phone Number __________________________________________________________________
How long has the nominee lived in Gilmer County? Total years: ________
How does this person meet the criteria for this recognition in the following areas?
Civic & Community: (include civic, religious, political, educational, government and social activities. List significant
contributions or achievements as related.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Page 1
Gilmer County Citizen of the Year- A Lifetime Achievement Award
Nomination Form
Business & Professional Affiliations and Involvement: (include offices held, activities, and dates with each
organization. List significant contributions or achievements as related.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Awards (list any significant awards of achievements)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please state in the space given below why your nominee should be selected as the Gilmer County Citizen
of the Year.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Additional information may be submitted along with this form.
_______________________________
__________________
Signature of Nominator
Date
*In the event your nominee is not selected you are encouraged to submit the name in the subsequent year.
DEADLINE: Applications must be received by 5:00 pm Friday, December 2, 2016 at the following address.
No applications will be accepted after this deadline. The Gilmer Chamber serves as the facilitator for
the Citizen of the Year and is not involved in the selection process or nominations.
Gilmer County Citizen of the Year
Attn: Paige Green
Gilmer County Chamber of Commerce
P.O. Box 505
Ellijay, Georgia 30540
Page 2