Roseland's Role Model of the Year Award

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The 2nd Annual

Roseland’s Role Model of the Year Award Nomination Form If you are the person who is Nominating a Roseland Role Model for an Award, please write in your contact information below: Full Name: ________________________________ Address: __________________________________ E-Mail Address: ____________________________ Phone Number: ____________________________ I would like to Nominate the following person below to be awarded Roseland’s Role Model of the Year! NOMINEES CONTACT INFORMATION: Full Name: ________________________________ Address: __________________________________ E-Mail Address: ____________________________ Phone Number: ____________________________ WHAT IS THE PURPOSE FOR THE ROSELAND ROLE MODEL OF THE YEAR AWARDS? These awards, by a written nomination, will be presented each year to individual(s) who best demonstrate the following: Commitment and dedication to the enhancement of Youth Recreation, Sports and/or Art activities on the local or state level, and/or seen as a true role model; encouraging and supporting local youth to actively participate in Recreation, Sport or Art programs; and/or Is respected by their peers and the public as positive role models to local youth. RULES AND REGULATIONS: To nominate YOUR choice for "Roseland Role Model of the Year", you must submit the nominee's name and their contact information above as well as a written paragraph or as an attached “MS WORD” Document detailing examples of why you feel this person deserves to be awarded this year's "Roseland Role Model of the Year"! The nominee must be either a current Roseland resident for at least three years or a person who (not limited to) works, teaches, coaches in Roseland and has interaction through activities with the Roseland Youth. The Nominee must be at least 21 years of age. Nominations must be submitted by one person. You are not able to nominate yourself. Petitions will not be accepted. All other Program Rules and Regulations must be followed. The reviewing committee for all nominations is the Roseland Recreation Booster Association’s Board of Directors.

Roseland Recreation Booster Association, Inc. P.O. Box 102 Roseland, NJ 07068 www.RoselandBooster.com

[email protected]

DEADLINE DATE FOR NOMINATIONS IS FRIDAY, JUNE 12, 2013. The Awards Dinner will be held Monday September 16, 2012 at 6pm. This will be held at the Hanover Manor. This Event is open to Families with Children and Adults. It will be part of the combined Annual Golf Outing Celebration Dinner. PLEASE SUBMIT YOUR NOMINATION FORM TO: E-Mail and attach a scanned version of this Nomination Form to: [email protected] Send via U.S. Mail your Nomination Form to: Roseland Boosters P.O. Box 102 Roseland, NJ 07068 ATT: “Roseland Role Model Nomination Form"

Detail why this Nominee should be awarded “Roseland’s Role Model of the Year Award”. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Roseland Recreation Booster Association, Inc. P.O. Box 102 Roseland, NJ 07068 www.RoselandBooster.com

[email protected]