City of Newton
Parks and Recreation Commission
Nomination for Youth Service June 2011

Please submit form online, or by fax or mail by May 27, 2011 to:
Nancy Scammon(nscammon@newtonma.gov)
fax: 617-796-1512
Newton Parks and Recreation Department
70 Crescent Street
Auburndale, MA 02466

Description of Awards

Download Award Application

Name of Nominee
Birth date
Address
Village
Phone
Name of Organization
& Years Involved

Please Check Award for Which Nominee is Being Considered

Adult Awards will be judged on the basis of a person's contribution and involvement in youth programs in Newton
Youth Awards will be judged on the basis of demonstrated good citizenship and service to their fellow youth or community
Describe why you believe this candidate should receive this award

Name of Nominator
Nominator Phone Number
Address of Nominator