Questionaire

Community Volunteer Shocker of the Week

A community can’t function without the helping hand of gracious volunteers. Communities will only go as far as those inside of them and that is why Wichita State University and Wichita Mid-Continent want to reward the individuals that are serving your community. Please nominate and let us know who you think should be the Volunteer Shocker of the Week, and why. The process is simple, fill in the proper form and tell us the nominee's story and how they have positively impacted the Wichita community. Those who serve individuals in need should be recognized, and Wichita State University and Wichita Mid-Continent are here to do so!

Required Fields in Bold


NOMINEE INFORMATION

	NAME:

	ADDRESS:

	CITY:

	STATE:

	ZIP CODE:

	EMAIL ADDRESS:

	HOME PHONE:

	CELL PHONE:

	ORGANIZATIONS HELPED INCLUDE:

	WHY ARE YOU NOMINATING THIS INDIVIDUAL?

	PLEASE DESCRIBE THE IMPACT THIS INDIVIDUAL HAS HAD ON THE COMMUNITY


NOMINATOR INFORMATION

	YOUR NAME:

	YOUR ADDRESS:

	YOUR CITY:

	YOUR ZIP CODE:

	YOUR EMAIL ADDRESS:

	YOUR HOME PHONE:



	YOUR CELL PHONE:

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