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2015 Champion for Children Nomination Form
Nomination Forms due by Friday, May 8, 2015
The Anson County Partnership for Children is requesting nominations for the 2015 Champion for Children
Award. This award will be presented to the individual who has been a champion for children in Anson
County and demonstrated the Partnership’s mission of “helping make Anson County a better place to be
a child and to raise a child.”
This Champion for Children award will recognize an individual who:
• Champions the well-being of children in Anson County.
• Demonstrates commitment to providing a better future for children in Anson County.
• Works with others to raise awareness about children's issues.
• Believes in building strong families.
• Demonstrates leadership on behalf of children in Anson County.
The award will be presented at the 2015 Champions for Children Reception on Thursday, May 28th at First
Presbyterian Church, Wadesboro, 6:00 pm.
Name of nominee for 2015 Champion for Children Award ______________________________________
Employer or Past Employer of nominee _____________________________________________________
Address of nominee ____________________________________________________________________
_____________________________________________________________________________________
Phone number of nominee _______________________________________________________________
Email address of nominee _______________________________________________________________
1. Explanation of how nominee has “helped make Anson County a better place to be a child and to raise
a child.” Please include in what capacity nominee has been a champion for children. Please attach
additional pages to this nomination form.
2. How many years has nominee “helped make Anson County a better place to be a child and to raise a
child?” ____ years (since ____ )
Nomination submitted by ________________________________________________________________
Address ______________________________________________________________________________
Phone Number ________________________________________________________________________
Email Address _________________________________________________________________________
Date Submitted ________________________________________________________________________
Please return this nomination form no later than Friday, May 8, 2015
Anson County Partnership for Children
117 South Greene Street Wadesboro, NC 28170
704-694-4036