Golden eagle award nomination form

Golden Eagle Award Recognizing those who soar above & beyond.

OFFICIAL NOMINATION FORM Dollar Energy Fund is proud of our partnerships with Community Based Organizations, Utility Companies, and Community Members. We recognize the impact that our partners, customers and friends have on our organization’s mission. We would like to publicly honor those individuals who consistently “Soar Above and Beyond” in their efforts to help Dollar Energy Fund assist our neighbors in need at Dollar Energy Fund’s 32nd Annual Luncheon Friday, September 11, 2015.

NOMINATION CRITERIA AND ELIGIBILITY Who is eligible for nomination?

Any staff member or volunteer of a Dollar Energy Fund affiliated community-based organization, utility partner, foundation, government entity or Dollar Energy Fund’s Board of Directors who has demonstrated:  Going the extra mile for others;  Treating every client (co-worker, partner) as if they were their sole concern;  A great attitude that supports their organization and the mission of Dollar Energy Fund;  Making their organization a better place to be, and;  Soaring above and beyond in helping Dollar Energy Fund achieve our goals.

DEADLINE All nominations must be submitted no later than August 4, 2015, to be eligible for consideration. Please return all forms to: 1. Electronically submit to mhaudrich@dollarenergy.org

OR

2. Fax nomination to Michelle Haudrich at 412-431-2085

Golden Eagle Award We want everyone to know what a great job Dollar Energy Fund’s partners do! Take a few moments to fill out the form below and let us know who you think should be one of our Golden Eagle Award Winners.

Self-nomination is allowed. Please fill out the form completely.

NOMINATOR INFORMATION: Name: Organization: Address: Phone Number: Email Address:

NOMINEE INFORMATION: Name: Organization: Phone Number: Email Address: Nominee’s connection to Dollar Energy Fund (i.e. utility representative, agency intake worker, etc.)?

What activities does the nominee perform that directly relate to Dollar Energy Fund (i.e. completing Dollar Energy Fund applications, grant-making, special program involvement, effective & compassionate counseling, outreach/promotion, issue advocacy, etc.)

Provide up at least three specific instances where the nominee has “soared above and beyond” to assist neighbors in need.

1.

2.

3.

Please attach additional pages if needed.

Submit all completed nomination forms no later than Monday, August 4, 2015 to: mhaudrich@dollarenergy.org OR Fax nomination to Attn: Michelle Haudrich at 412-431-2085.

Thank you for helping us honor those who “Soar Above and Beyond” to support Dollar Energy Fund’s mission!