Community Partnership Award Nomination Form

Community partners must have voluntarily contributed to a literacy program or to a literacy community.
Community partners must be currently active or must have provided service within the past year.
Strong candidates are community partners who have:
- Positively influenced adult literacy in Minnesota.
- Contributed unique, innovative or creative perspectives to adult literacy programs.
- Shown dedication by the length of involvement or by a strong concentration of service.
ABE staff, MLC staff or board members, and former Community Partnership Award winners are ineligible.
Nominations are due by 5:00 p.m. on Friday, March 22, 2013.

Community Partner Information

First Name *

Last Name *

Street Address *

City *

State

ZIP Code *

Phone *

Email *

Your Information

First Name *

Last Name *

Street Address *

City *

State

ZIP Code *

Phone *

Email *

Title *

Program Name *

Program Location *

Please answer ALL of the following questions.

How long has this group or individual been involved with your organization (50 words or less)? *

How did this group or individual first become involved with your literacy program (50 words or less)? *

What role(s) does this group or individual currently play (200 words or less)? *

In what way is this group or individual’s involvement in your program unique, innovative or creative (200 words or less)? *

Briefly describe the impact this group’s involvement has had on your program and on the learners in you program (200 words or less). *

Additional comments:

If you have additional documentation for this nomination, please email, fax or mail them to:

Cathy Grady
Minnesota Literacy Council
700 Raymond Avenue, Suite 180
St. Paul, MN 55114
cgrady@mnliteracy.org
fax: 651-645-2272

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