2013 Good Neighbor Award Nomination Form
RequiredRequired Question(s)
Thank you for taking the time to nominate an organization and/or individual who deserves to be given a "Good Neighbor" Award at the 7th Annual Good Neighbor Festival and Picnic on Saturday, September 28th. All nominees should be affiliated with the Fifth Council District (live, work, play, or attend school).

Councilwoman Gerrie Schipske
Required 1.
Please indicate which category you are nominating for:
Youth (under 25 years of age)
  • Comment:

  • 500 characters left.
Required 2.

Please provide the full name of your nominee (individual or organization):


50 characters left.
Required 3.

Please provide the nominee's full address


350 characters left.
Required 4.

Please provide your nominee's phone number:


50 characters left.

Please provide your nominee's email address.


50 characters left.
Required 6.

Please describe why you are nominating this individual or organization for the 7th Annual Good Neighbor Award:


1000 characters left.
Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Home Phone:
Email Address:
Address 1:
Address 2:
Postal Code:

Thank you for helping the Fifth District honor our Good Neighbors.