Human Rights Award Nomination Form

It is important to provide all of the information asked below and include the achievements the candidate has undertaken with respect to improving equality for all people in Prince William County.

Please remember that they must be an individual, group, or youth that lives within Prince William County in order to be an eligible candidate. Forms should be emailed or post-marked no later than December 9, 2023 addressed to the Human Rights Commission’s Office.

2. Nominee Information: *This question is required.

Candidates First Name

Candidates Last Name

Street Address

City

State

Zip

Email Address

Phone Number

3. Nominated By (Full Name of the individual and/or organization—if applicable): *This question is required.

First Name

Last Name

Street Address

City

State

Zip

Email Address

Phone Number

4. In approximately 250 words, the reasons to consider the Nominee. Again, as stated above, this statement should include a description of activities the candidate has undertaken with respect to promoting the equality of all people. The statement should contain descriptions of volunteer or paid work with the names of organizations. Describe the level of the candidate’s responsibilities within these organizations or the community. *This question is required.