Family contact - Please provide the name and contact information of a relative or close friend of the honoree (other than the nominator) that we may use as a back-up contact.
Street address: City/State/Zip:
Day phone: E-mail:
Relationship to nominee:
Nominator information - Please provide your contact information. If you are nominating on behalf of an organization, please note so along with your name. You will be notified if this nominee is or is not selected.
Street address: Day phone:
Organization (if applicable):
By checking the box below, you attest that you have verified that the information provided on this nomination form and any related attachments is factual and accurate.
I do so attest.
Nominee's consent - By checking the box below, you attest that you have received consent from the nominee or his or her representative to submit this nomination. We may request a signature of consent to verify. Nominations without consent will not be considered.
I do so attest.
Essay - Please type or paste below an essay that explains why you feel the nominee is worthy of being inducted into the Ohio Senior Citizens Hall of Fame. Your essay should be approximately 1,000 words. Include the following information as applicable:
Details of contribution(s) and achievement(s) - Please be as descriptive and specific as possible. Describe the who, what, when, where, why and how of those efforts that make the nominee worthy of selection. Include dates.
Length of service - Describe how long the nominee engaged in this endeavor and indicate if he or she is still working to that end. Include beginning and ending dates.
Impact of contributions and accomplishments - Describe how the nominee’s work, advocacy or other endeavors helped Ohio respond innovatively to its growing and changing aging population, or explain the degree to which the nominee is a respected member of society who seeks and takes advantage of opportunities to grow, thrive and contribute.
Positive image of aging - Explain how the nominee sets an example for his or her peers and younger generations by leading an active and positive life not defined by age or barriers.
Awards, recognitions and honors - – Briefly list only honors relevant to the field(s) of endeavor for which the person is being nominated, and for each one, give dates and briefly describe the significance.
Boards, commissions and organizations - Briefly list only those affiliations that are relevant to the field(s) of endeavor for which the person is being nominated. Describe the capacity of service and any offices held along with the number of years the nominee held those offices.
Other materials - You may submit other materials (e.g., résumé, news articles, commendations, photos, etc.) to support your nomination, provided they are relevant to the field(s) of endeavor for which the person is being nominated. Please call 614-728-0253 for instructions on submitting additional documentation. Do not send originals, we cannot return them.