B.R. Ashby, M.D. Award for Outstanding Community Service Nomination Form

Nominations are due Friday, September 5 at 8 pm.
If you have questions, please contact Reggie Singletary, Senior Program Officer at 434-799-2176.

Please attach your response to the question below in the field provided at the end of the form.
Limit your response to three (3) typed, double-spaced pages, using a 12-point font with 1-inch page margins.

Why do you think this organization deserves the Danville Regional Foundation's B. R. Ashby, M. D. Award for Outstanding Community Service?

Be sure to include information about:

How the organization has improved the quality of life of residents in the Region.
How the organization has demonstrated a commitment to caring and generosity of spirit.

Fields marked with an (*) are required and cannot be left blank

About the Nominee

Name of Nominated Organization *

Nominee Address *

Nominee Phone *

Nominee City *

Nominee State *

Nominee Zip *

Chief Executive Officer *

Nominee Email *

About the Nominator

Affiliation with Nominated Organization *

Nominator's Name *

Nominator's Email *

Nominator's Address *

Nominator's City *

Nominator's State *

Nominator's Zip Code *

Answer Document File Attachment (Word or PDF files only) *