Nomination Form for the Madelyn Pyeatt Award   A red asterisk (*) means the information is required. Honors Sierra Club members who have made outstanding contributions through working with youth. Includes a $500 award to further the work of the recipient(s).   1. Basic information about the nominee.   *Nominee's Full Name(s):  *Nominee's Address:   *Nominee's City:   *Nominee's State:   *Nominee's Zip:   *Nominee's Phone:   *Nominee's Email:   Nominee's Group:   Nominee's Chapter:   Name of Chapter Chair:   If this nomination is for group- or chapter-related work, does the nominee's group or chapter ExComm support this nomination? Yes     No             2. Qualifications for the Award.   *What accomplishments qualify the nominee for this award? Make your case here that the nominee above deserves this award.     *If this nominee receives this award, how will your group or chapter use the prize money?   *Does your group or chapter have an account with the Sierra Club Foundation? If so, please give the name or number of the account.     Has this nominee received previous recognition for his/her work? Yes     No         If yes, by whom? When?   Names and addresses of local newspapers to notify if nominee wins:   Group Newsletter: Contact Info: Chapter Newsletter: Contact Info:     3. Basic information about yourself.   *Your Full Name:  *Your Club role:  *Your Address:  *Your City:   *Your State:   *Your Zip:   *Your Phone:   *Your Email:     Documentation is critical for most awards. In addition to the above information, nominations should include a set of supporting materials such as news clippings, testimonial letters, and samples of the nominee's work. Please put supporting materials in a binder and mail it to: Ellen Davis, 405 E. 10th St., Georgetown TX 78626. Please do not send large attachments or multiple attachments by e-mail.       Questions? Contact Awards Committee Chair Ellen Davis. Up to Top