Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Outstanding Partner Nomination Form
Nominate an individual, organization, or business who deserves to be recognized for efforts to reduce substance misuse in Carter County TN
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name of Nominee
*
Your answer
Phone of Nominee
*
Your answer
Email address of Nominee
*
Your answer
Organization of Nominee
*
Your answer
Nominee Sector
*
Youth
Parents
Business
Healthcare
Religious/Fraternal
Government (local, state or tribal)
Youth Serving
Law Enforcement
Schools
Media
Civic/Volunteer
Other Organization that works to reduce substance use
Date Nominated
*
MM
/
DD
/
YYYY
Nominated By
*
Your answer
How has the nominee contributed to the efforts of Carter County Drug Prevention Coalition?
*
Your answer
Why do you feel this nominee is worthy of recognition?
*
Your answer
How has the nominee gone above and beyond throughout the partnership with CCDP?
*
Your answer
Describe any other ways the nominee serves Carter County to prevent substance misuse.
Your answer
Thank you for your participation and nominations for Outstanding Partners. Winners will be recognized during the monthly Carter County Collaborative (CCC) monthly meeting, in the newsletter and future magazine, as well as in other media outlets.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
