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The 2007 Elsie B. Schlivek "Help Realize a Dream Award" Nomination Form

To be eligible for an award, one must be a resident or active in the northern New Jersey area served by Children's Aid and Family Services, Inc.; be 55 years of age or older; and be engaged in the pursuit of a goal which has the quality of realizing a dream, either life-long or of more recent origin. Candidates may be nominated by someone or be self-nominated, but in all cases, a candidate must have a sponsor (friend, teacher, associate, etc.) who should complete the appropriate portion of this form.

You can also use the PRINTABLE FORM (PDF) for mailing or faxing. After filling out form, you may either mail it to 200 Robin Road, Paramus, NJ 07652, Attn: Rita Ward, or fax it to 201-634-3672, attention: Rita Ward, no later than August 31, 2007.

Today's Date:
Nominee's Information
Name:

Date of Birth:

Address:

City, State & Zip:
,   

Phone:

E-mail Address:
Description of Goal/Dream (Please include details as to the origin of this goal, current status of progress toward achieving it, what it means to you to accomplish this particular goal or realize this dream).

Sponsor's Statement
Relationship to Nominee:

Length of time you have known nominee:

What you know of nominee's goal/dream:

Name:

Address:

City, State & Zip:
,   

Phone:

     


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