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Diana C. Jones Award Nomination Form

Nominee Information Organization Name (required)

Mission Statement (required)

Name (required)

Age (required)

Title/Position

Mailing Address (required)

City (required)

ZIP Code (required)

Phone Number (required)

Fax Number

Email Address

Question and Answer

Please capture the essence of how the organization has positively impacted the lives of older adults in an exemplary and compassionate way by briefly answering the following questions:

What is the organization's role in providing paid or unpaid service to older adults?

How many people are affected by the organization's leadership?

What amount of time do the employees devote to this work?

What is the organization's exemplary volunteer program or project for older adults?

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