Nominations Form

We ask that you please use this online form for your submission. However, if you are experiencing issues with the online form, you may download the PDF version:

Nominations Form 2022

NOMINATIONS DUE September 30, 2022

IDENTIFICATION OF THE NOMINEE

FULL NAME OF NOMINEE *

First

Last

NOMINEE ADDRESS *

NOMINEE PHONE *

NOMINEE EMAIL *

DESCRIPTION OF NOMINEE’S CONTRIBUTIONS

MISSION STATEMENT: The mission of Living Legends of Alexandria is to identify, honor, and chronicle the lives of individuals who have contributed to the community in an exemplary and lasting way that has significantly impacted the quality of life in Alexandria and serves as an inspiration to others.

To what extent has the Nominee made an exemplary contribution to the community in conformance with the Mission Statement (above)? *

How has the Nominee’s accomplishments impacted the quality of life in Alexandria? *

What is the lasting significance of the Nominee’s efforts that will inspire others? *

Note: Nominees need not reside in the City of Alexandria. Only single individuals or a team of two persons working together are eligible to be nominated. If a team of two persons is nominated, they must be nominated for collaborating on the same innovation, project, program or achievement. If premised upon accomplishments in their employment, however, the basis of the Nominees’ contributions MUST be above and beyond carrying out their expected responsibilities. Anyone running for, or while holding, an elected office is not eligible for nomination, nor are current members of the Living Legends of Alexandria Board of Directors or any employees and agents of the organization.

File Upload – Support Documentation

Click or drag a file to this area to upload.

The nomination may include NO MORE than ten pages of supporting documentation.

IDENTIFICATION OF THE NOMINATOR

NAME OF NOMINATOR *

First

Last

NOMINATOR ADDRESS *

NOMINATOR PHONE *

NOMINATOR EMAIL *

Confirm Email

SUBMISSION DATE – Today's date *

SIGNATURE *

First

Last

Electronic Signature Agreement. By checking the “I Accept” button below, you are signing this Nominations form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form. By selecting “I Accept” you consent that all the information you have provided above is factually true to the best of your knowledge.

"I ACCEPT" *

I understand that checking this box constitutes a legal signature confirming that I acknowledge that the information I have provided above is factually true to the best of my knowledge.

Name