2. Part 1- Please enter your info as the nominator.
4. Your Name*
5. Your Email Address
7. Phone Number*
8. Community*
   -- Select One --Resident of EdwardsvilleCity EmployeeResident & EmployeeOther
12. Part 2 - Please enter as much as you can about the nominee(s) along with the contribution or action.
14. Name of nominee(s)*
15. Contact information for nominee (phone, address, email)
17. Description of contribution(s), achievement, act, and/or deed including date and location*
19. Photo or video of contribution if available
21. Thank you for your part in recognizing residents whose generous efforts, contributions, and achievements foster and enhance civic pride.
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field