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2. Name of Resident Being Nominated*

   Please list their full name

4. Resident's Address*

   Nominee's must be and Orange resident. Please list their home address.

6. Reason for Nomination*

   Have you seen this resident doing specific tasks to help the community?

8. Does this person volunteer specific services in Orange?*

   1. Yes
   2. No
9. Please explain how they volunteer in Orange.*

   Include how often, how long they have done it for, and the community impact.

11. Does this person participate in other activities?*

    Please list.

15. Name of Person Making the Nomination*
16. Phone Number*
18. All Nominations are due at the Board of Selectman's office by May 1st.

    Thank you for taking the time to help us recognize those who make Orange a better place to live.

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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field