NOMINATION APPLICATION

	Attach supporting information as follows: Using the category descriptions included with this form, describe the act of service, volunteerism, philanthropy or achievement and why you feel this is significant.
	All applications must be typewritten, double spaced and no longer than 2 pages.
	Submit two (2) copies of each application.
	Select one category that best fits your nominee, or write other if you are unsure about the category.
	If the nominee is an organization, please include a contact name, address and phone number.
	Write the nominee’s name at the top of each page.
	Past CLvFFie recipients are ineligible, as are those who have been finalists more than once.
	CLVFF Trustees, Selection Committee Members, or their relatives are ineligible for consideration.

CLvFFies:The purpose of this awards program is to recognize Conejo/Las Virgenes area individuals and/or organizations making a significant impact on the community. Nominees must work or reside within the Conejo and Las Virgenes area.

Category (over for descriptions): __________________Date Submitted: ____________

Nomination is: _________work related _________ volunteer service. (check one)

♦Name of Nominee and/or Contact Person if a group:____________________________

Address:________________________________Phone___________________________

City:____________________________________Zip_____________________________

Name of nominator: ____________________________________________________ __

Address:_____________________________________Phone:_____________________

City:____________Zip:_______________________
e-mail_________________________

♦Please check here if you do not want this person to receive notification that they have been nominated:___

Please return this nomination form no later than Monday, June 30, 2008 to the Conejo/Las Virgenes Future Foundation at the address below.