Community Recognition Form
the “Neighborlies”
Person nominated:
NAME: ____________________________________ PHONE: ______________
ADDRESS: ____________________________________________________________
Check the Category person nominated for:
______ NEIGHBORLY ACTS _______ GROUPS PULLING TOGETHER
______ BEAUTIFICATION ______ BUSINESS/AGENCY SUPPORT
THE REASON YOU ARE NOMINATING THE PERSON (S) FOR THE COMMUNITY RECOGNITION AWARD:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Person nominating:
NAME: _____________________________________PHONE:___________________
ADDRESS: ___________________________________________________________
Call Kathy or Natalie at the Northern Berkshire Community Coalition: 663-7588 to nominate someone or bring the form to the coalition office, 85 Main St., Suite 624, North Adams.