Your First Name

Your Last Name

Your Email

Name of Nominee

Nominee Phone (numbers only)

Nominee Email

What region does the nominee volunteer? NorthwestSouthwestNorth CentralSouth CentralNortheastSoutheast

Is the nominee 16 years or older? YesNo

Has the nominee received the J.W Volunteer Service Award or National Board of Directors Regional Award in the past 3 years? YesNoNot sure

Total length of volunteer involvement with Canine Companions (minimum 1 year)

Typical commitment of time in the current year

Nominees’ primary volunteer tasks and opportunities in the current year

Describe nominees’ exceptional volunteer accomplishments and community impact

Comments