Extra Mile Award Application

All nominating organizations should appoint a representative to work with the nominee; this will help ensure an accurate and high quality nomination for submission. The quality of the nomination will play an important part in determining recommendations by the selection committee.
Only complete nominations will be accepted (see below). Nominations may either be completed on-line by March 12th 2012 or be mailed NLT March 8th to: The Alliance for Youth, PO Box 13579, Arlington, TX 76094.
All nominees must confirm in their nomination that they will attend the luncheon.

Organization Information
Nominating Person:

Organization:	Position with Organization

Phone Number:	Email:

Candidate Information
Candidate Name:	Age:	Years with Organization:

Address:	City

State:	Zip:

Candidate Involvement
Servant Profile (500 words max): Provide examples of how the nominee demonstrated the value of servitude.
Leader Profile (500 words max): Provide examples of how the nominee led community efforts.
Service Profile (500 words max): Provide key dimensions of the nominee's service to the community.
Attendance: Nominee will attend the First Rate Living Luncheon on April 19th. (check to indicate nominees commitment to attend).
Waiver Agreement (Please check waiver to indicate your agreement with this statement): All letters of nomination must include the following statement: "Our organization and our nominee (provide name: ) understand that the decision of the selection committee and board are final and we waive our rights to dispute or challenge that decision."
Letters of Recommendation: I understand that (1) two letters of recommendation are required; (2) Letters should be prepared by Alumni, Parent, or Organization member; and (3) Each letter must include contact information of person preparing the letter. These letters may be uploaded on the next page after submitting this form by March 12th or should be mailed to The Arlington Alliance for Youth, PO Box 13579, Arlington, TX 76094, prior to March 8th, 2012.