TW Anderson Nomination Form

Name of Nominee

Nominee's Email Address

Nominee's Address

Nominee's Phone Number

Nominee's Birthday

YYYY

Nominee's Spouse

Nominee's Child(ren)

Number of Grandchildren

Has been a member of an Evangelical Covenant Church since (year)

Current Member at (Church Name)

Church's City & State

Elected positions which nominee has held within the local church

List significant contributions to the life of the local congregation

Has the nominee, to the best of your knowledge, ever served on a denominational board?

I don't believe so

Note any involvement—locally, regionally, and/or nationally—which the nominee has had in other Christian organizations/institutions/ministries (i.e., F.C.A, B.S.F., Billy Graham, etc.)

Occupation

Position Title

Most Recent Employer

Summarize earlier employment history

Indicate awards, honors, citations, accomplishments by which the nominee has been recognized professionally and vocationally:

Note any professional organizations, associations, unions, etc. in which the nominee has provided participation or leadership:

COMMUNITY SERVICE - Describe the nominee's involvement in the local community in terms of other volunteer involvement, community service recognitions received, etc.

OPTIONAL ADDITIONAL INFORMATION - You are invited to provide a biography, news releases, etc., which will be of assistance to the committee in reviewing this nominee.

REFERENCE LETTERS/NOTES - You are invited to attach no more than three (3) letters or notes from individuals who can support this nominee's candidacy for The Theodore W. Anderson Award.

First Letter

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Second Letter

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Third Letter

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Name of Nominator

Date of Submission

YYYY

Address

Primary Phone Number

Office Phone Number