MLK YOUTH RECOGNITION AWARDS
REV. DR. MARTIN LUTHER KING DAY: JANUARY 18, 2016
The Paterson Youth Council is honoring the city’s best of the best:
the young people (and one adult) who make Paterson a better place for all! There will be
several youth winners, one adult winner, and one youth-serving organization.
NOMINATION FORM
Nominations are due no later than Friday, January 8, 2016. Nominees should be available on Monday, January 18,
2016 in the morning to attend the Paterson Youth Council’s MLK Recognition Awards Breakfast. Please fill out the
nomination form and email Matt Schleifer at [email protected] or Eddie Gonzalez at [email protected] for
more information or any questions. Details on where to send completed forms are on the back page.
PART 1: NOMINEE’S INFORMATION
The following information is needed for the person you are nominating to be honored.
______________________________________________________________________________________
First
Middle Initial
Last
Gender: □ Female
□ Male
Age: __________
Date of Birth: _________________
Mailing Address: _______________________________________________________________________
Street Number
Street
Apt #
City ________________________________________
State __________
Phone Number: _______________________________
E-mail (important):_______________________
School: ______________________________________
Grade: ___________ GPA: ___________
Grade Level:
□ Middle School
□ High School
(6-8)
(9-12)
□ Adult
ZIP___________
□ *Organization
*(Paterson organizations only)
Is the nominee affiliated with any other groups? (Church groups, community organizations, etc?) Please list:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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PATERSON YOUTH COUNCIL MLK YOUTH RECOGNITION AWARDS
NOMINATION FORM
PART 2: NOMINATION DETAILS
The four questions numbered below are necessary for the applicant to be considered. Please answer the four
questions on a separate piece of paper and attach.
Nominee’s Name_______________________________________________________________________
Your Name_______________________________
Relationship to Applicant______________________
1- How long have you known the applicant and in what capacity?
2- How has this nominee made a positive impact on the lives of Paterson’s youth?
3- How has this nominee’s contribution represented the legacy of Dr. Martin Luther King, Jr.?
4- Please provide any additional information that you wish to share about the nominee.
PART 3: YOUR INFORMATION
The following information is needed from you, the person who is nominating a Paterson resident for the MLK
Award.
________________________________________________
First
Middle Initial
Last
Gender: □ Female
□ Male
Date of Birth: ___________ E-mail (important)________________________ Phone Number: ______________
Mailing Address
______________________________________________________________________________________
Street Number
Street
Apt #
City _________________ State __________
ZIP___________
If you are a student making this nomination, please answer below:
School: ____________________________________ Grade: _____________________________
If you are an adult making this nomination, please answer below:
Employer: __________________________________ Position: __________________________
Are you affiliated with any local churches, community organizations, etc? Please list:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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PATERSON YOUTH COUNCIL MLK YOUTH RECOGNITION AWARDS
NOMINATION FORM
PART 4: REFERENCES
Please provide the following contact information for two adults, other than yourself, who would be willing to
speak about the person you are nominating and his or her impact on the youth in Paterson.
REFERENCE ONE
__________________________________________
First
Middle Initial
Last
__________________________________
School or Organization:
Phone Number: _____________________________
E-mail (important):________________________
REFERENCE TWO
___________________________________________
First
Middle Initial
Last
__________________________________
School or Organization
Phone Number: ______________________________
E-mail (important):________________________
All nominations are due no later than Friday, January 8th!
Please see next page for details.
Please direct any questions to the PYC Advisors:
Matt Schleifer at [email protected] or
Eddie Gonzalez at [email protected]
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IMPORTANT INFORMATION
Nominations must be received no later than January
8, 2016.
Nominations will not be accepted after this date.
Nominations can be mailed to:
Paterson Youth Council
ATTN: Eddie Gonzalez
NJCDC
PO Box 6976
Paterson, NJ 07509-6976
Nominations can be hand delivered between
the hours of 9:00am & 5:00pm, M-F to:
NJCDC/PYC
ATTN: Matt Schleifer or Eddie Gonzalez
32 Spruce Street, Third Floor
Paterson, New Jersey 07501
(at the corner of Spruce and Market Streets, next
to Burger King; brick building with green trim)
FREQUENTLY ASKED QUESTIONS
When are the nominations due?
All nominations are due not later than Friday, January 8, 2016. Address and contact information can be found
below.
How does the selection process work?
The Paterson Youth Council consists of 30 Paterson High School students. The council will review all nominations
and make the final selections.
When and where are the Paterson Youth Council Youth Recognition Awards?
The Paterson Youth Council Youth Recognition Awards Ceremony will be held on Dr. Martin Luther King Day,
Monday, January 18, 2016, at 11:00 am at the Brownstone, 351 West Broadway in Paterson.
When and how will the nominees be notified of the Paterson Youth Council’s decision?
All nominees will be notified of the Paterson Youth Council’s decision via mail and email. Notification letters will
be mailed on or about Monday, January 11, 2016.
I have more questions. I need more nomination forms. What do I do?
For any information, please call the Paterson Youth Council Advisors at the below contact information.
All nominations are due no later than Friday, January 8th!
Please direct any questions to the PYC Advisors:
Matt Schleifer at [email protected] or
Eddie Gonzalez at [email protected]
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