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Photo courtesy John Winters

Thanks to The Boren Foundation, and Jack and Karen Kay Leonard for making this website possible. 

Lead-Safe Indiana Awards 2001

Application Form

Award Category: A person or organization can be nominated for more than one category.

 

 

Nominee Information:

Name of Nominee: _____________________________ If an organization, number of employees:  ____________

Organization Type: (circle one)

  • Government  
  • Nonprofit Organization
  • Hospital
  • Business
  • Individual

Name of Contact Person: ________________________ Address: ____________________________________

City: ___________________ State: __________ ZIP Code: ___________ County:  ____________________

Daytime Phone Number: _______________ Fax Number: ______________ E-mail Address: _________________

Person Submitting Nomination (if different from above):

Name of Nominee: _____________________________ If an organization, number of employees: _____________

Organization Type: (circle one)

  • Government
  • Nonprofit Organization
  • Hospital
  • Business
  • Individual

Name of Contact Person: ________________________ Address:_____________________________________

City: ___________________ State: __________ ZIP Code: ___________ County: _____________________

Daytime Phone Number: _______________ Fax Number: ______________ E-mail Address: _________________

Is the person/organization being nominated aware of the nomination?    Yes   No

Provide a brief summary of the project for data entry purposes only. The review committee will judge your project based on your complete answers to the questions on of the awards informational brochure.

 

 

 

 

In an attachment, answer the following questions. Please keep it to less than four pages.

  1. Describe leadership effort by individual or organization.
    • Who or what area benefited by the effort?
    • What is the background of the individual or organization?
    • What was done?

     

  2. Explain why the effort demonstrates leadership.
    • Is it innovative?
    • Is it comprehensive?

     

  3. Provide a description of the results of the effort.
    • Are there any measurable results?
    • How did the effort make a difference?