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Survey/Form Review
City of Santa Clara Nomination Form
Name of Individual Being Nominated
First Name:
Last Name:
Title (if applicable):
Address:
Select one category for nomination:
Tell us about the individual you are nominating. What activities, actions and important tasks have they undertaken which benefit the Santa Clara community? What significant accomplishments have they achieved and how have they distinguished themselves, in order to be considered for an award? Be as specific as possible. List other honors or awards the individual may have received. Attach an additional sheet if needed.

Please provide your contact information, so that we can contact you, if needed, for more information about the person you are nominating:
Your First Name:
Last Name:
Address:
Phone Number:
Email:
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