Nomination Form

2011 Nomination Period: August 1 through 5 p.m. on September 9, 2011

Town of Cary
Hometown Spirit Award
Nomination Form

Refer to the instructions that accompany this nomination form. All information on and included with this form is considered a public record and will be released to others upon request. All materials submitted with this nomination form will be retained by the Town of Cary. Please type or print to ensure legibility.

Nominee’s Name: ____________________________________________________________

Nominee’s Address: __________________________________________________________
(include complete street mailing address with town and zip code)

Nominee’s Email Address: ___________________________________________________

Nominee’s Phone Number: ____________________________________________________

Is the nominee 21 years of age or older? Yes _____ OR No _____
(Minimum award eligibility age is 21)

To the best of the nominators’ knowledge, none of the disqualifying factors on Page Two of this form apply to the nominee. Yes _____ OR No _____

Nominee must be nominated by two individuals, both of whom must be Cary residents.

Nominator 1:	Nominator 2:
Signature: (Not required if electronically submitted) ________________________________________	Signature: (Not required if electronically submitted) ______________________________________
Name: __________________________________	Name: ________________________________
Email: __________________________________	Email: ________________________________
Phone: __________________________________	Phone: ________________________________
Mailing Address (complete with street address, town and zip code): ______________________________________ ______________________________________	Mailing Address (complete with street address, town and zip code): ______________________________________ ______________________________________

Nominators should jointly summarize on a separate page (no more than one single-spaced 8 & ½ X 11 inch page with a font size of at least 10 points) why they believe this person should receive the Hometown Spirit Award. Comment specifically on all the applicable criteria (both general and specific as listed on the nomination instructions). Please do not include any additional materials as attachments.

Submit the completed application as instructed below (by email, fax or mail). To be eligible for consideration, the Town Clerk must receive the completed nomination form by 5 p.m. on September 9, 2011.

Sue Rowland, Cary Town Clerk
Email: sue.rowland@townofcary.org; or
Fax: (919) 460-4910; or
Mail:
Sue Rowland, Town Clerk
Town of Cary
P.O. Box 8005
Cary, NC 27512-8005

Questions? Contact Sue Rowland, Town Clerk, at sue.rowland@townofcary.org or
(919) 460-4941.

Hometown Spirit Award Nomination Form
Page 2

Disqualifying Factors

A person is not eligible to be a Hometown Spirit Award nominee if the person has been found guilty of any of the following crimes:

(Guilty means that a person was found guilty following a trial, entered a guilty plea, entered a no contest plea accompanied by a court finding of guilty, regardless of whether there was an adjudication of guilt (conviction) or a withholding of guilt. This recommendation does not apply if criminal charges resulted in acquittal, Nolle Prosse, or dismissal.)

Sex Offenses

All Sex Offenses, regardless of the amount of time since offense.

Felonies

All Felony Offenses, regardless of the amount of time since offense.

Misdemeanors

All misdemeanors involving a minor (unless the applicant was themselves a minor), regardless of the amount of time since the offense.
All misdemeanor violence offenses within the past 7 years.

All other misdemeanor offenses within the past 5 years or more than one offense in the past 10 years.

Pending Cases

We will ask the nominee to disclose to the Town if any of the above charges are pending at the time of nomination.