Peace Medal Nomination Form - YMCA Northumberland

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Medallion Category

Group/Nominee Full Name*

Nominee/Group Contact Email*

Nominee/Contact Phone*

Preferred Form of Contact*

Phone

Email

Provide a brief history of the individual, organization or group*

How has the nominee inspired you and others through their acts of peace?*

How does the nominee demonstrate the YMCA values of PEACE?*

What is the impact of the nominee’s peacemaking work on the local, national, or global community?*

Describe any collaboration between the nominee and other groups and individuals.*

Nominator Name*

First Last

Nominator Email*

Nominator Phone*

Nominator relationship to nominee*

Peace Medal Online Nomination Form