Reverend Dr. Martin Luther King, Jr. Awards Nomination Form
This form will nominate a citizen of Dane County, Wisconsin for the Rev. Dr. Martin Luther
King Jr. Awards.
Nominations must be submitted to the Department of Civil Rights by Friday, December 10, 2012, 4:30 p.m.
Commission members will independently rank the nominees, results will be compared and award recipients
will be chosen collectively by Committee members. The award(s) will be presented at the Dr. Martin
Luther King, Jr. Birthday Celebration in January 2013.
Nominee Information
Nomination Information
This Nominee has shown visible and continuing volunteer leadership or effort above the call in the following area(s):
Number of years this Nominee has been Actively Identified with the Dane County area:
Essay and Biography
Please answer the following questions and provide a brief biography of the nominee in the space provided below:
- How has your Nominee exemplified Dr. King’s non-violent philosophy?
- What impact has your Nominee had on the lives of people in Dane County?
- Has your Nominee had any special obstacles to overcome in order to achieve what s/he has accomplished? If so, please explain.