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KVUE'S FIVE WHO CARE NOMINATION FORM


IMPORTANT: Please remember our Five Who Care judges vote for your nominee based entirely on the information you provide. Please let us see a clear image of your nominee through your writing.
1.NOMINEE - Contact Information
First Name* M.I. Last Name*

Email Address* Daytime Phone* Evening Phone*
2.NOMINEE - Address
Street Line 1*
Street Line 2
City*
State*
Zip Code*
3.NOMINEE - Birthdate
*
4.NOMINEE - Occupation or School
*
5.

NOMINATOR - Contact Information
First Name* M.I. Last Name*

Email Address* Daytime Phone* Evening Phone*
6.NOMINATOR - Your relationship to the Nominee
*
7.Background information (Please provide information of the nominee's personal life, such as family, education, interests and anything else of relevance.) *
8.List past awards and recognition received by the nominee. *
9.References (Please send the name and phone number of one person who knows the nominee on a personal basis and the name and phone number of one person whose relationship is within the volunteer activity.)
*
10.Reasons for nomination (Please include all the nominee's volunteer activities, length of service and any accomplishments. Please list only volunteer work for which there was no compensation. Begin with present year and then list each preceding year.)*
11.Please use this section to describe your volunteer. Let us know their outstanding qualities. Give specific examples of the ways they share.*
An email will be sent to FiveWhoCare@kvue.com when you click submit. You can also mail or deliver by Jan 31, 2011 to:

FIVE WHO CARE c/o KVUE-TV.
Mailing Address:
P.O. Box 9927
Austin, TX 78766
Street Address: 3201 Steck Avenue Austin, TX 78757
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