The 7 over Seventy selection committee base their decisions on the information you provide in your nomination. Please be sure to submit a complete and thorough nomination that paints a clear picture of the contributions of your nominee to aid in the selection process.

If you would like to review some nomination guidelines and tips, please click here [link coming].

Nominee Contact Information

Please enter the nominee's information here.

Title (select one): *

Title (Other): *

Nominee's First Name *

Nominee's Middle Name:

Nominee's Last Name *

Suffix (if any): *

Suffix (if other): *

Race *

Ethnicity: *

Hispanic or Latino

Not Hispanic or Latio

Unknown

Home Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Nominator Contact Information

Please provide your contact information here.

Your Title (select one): *

Your Title if Other: *

Your First Name *

Your Last Name *

Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Career Accomplishments

List the top three (3) career accomplishments.

Workplace/Organization Name *

Job Title *

Career Accomplishment (1) *

0/250 words

Workplace/Organization Name

Job Title

Career Accomplishment (2)

0/250 words

Workplace/Organization Name

Job Title

Career Accomplishment (3)

0/250 words

Volunteer Activities

List the top three (3) volunteer activities and benefts to the community/organization. Be as detailed as possible and remember to include activity/organizatiion, time commitment and benefit to the community.

Community/Organization Served (1) *

Activity or Responsibility *

Time Committment *

Benefit to Community *

0/250 words

Community/Organization Served (2)

Activity or Responsibility

Time Commitment

Benefit to Community

0/250 words

Community/Organization Served (3)

Activity or Responsibility

Time Commitment

Benefit to Community

0/250 words

Community Membership

Tell us about community organizations or committees the nominee belongs to. Be sure to list any positions or offices held by nominee within these organizations and their length of membership.

Community Memberships: *

0/250 words

Service Awards

List outstanding accomplishments, awards, or honors the nominee has received and when.

Accomplishments, awards, or honors: *

0/250 words

Reason for Nomination

Sum it all up for us! Why do you think this nominee deserves the 7 over Seventy Award? *

0/500 words

We are not able to accept attachments or addendums to this form.

Completed nominations must be received before

11:59 pm on Friday, May 10.

2895 Shorefair Drive, Winston-Salem, NC 27105

info@seniorservicesinc.org