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* All fields are required.

Contact Information:

  • Name of the Champion you are nominating:
  • Champion's email address:
  • Champion's City & State:
  • Short descriptor of the Champion (e.g. student, teacher, organization or role that he/she/it plays to support youth):
  • What does this Champion do? (e.g. work, school, community activities, family):
  • Why is this person or organization a Champion?
  • How would others benefit from knowing this story?

Verification Code:

  

 

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