LifeStream Golden Hoosier Award Nomination

 

Guidelines

 

1. Nominee must be age 65 years or older on or before January 1, 2023.
2. Must have positively impacted members of a community, civic organization, or faith-based organization through volunteer efforts at least three years after reaching 60 years of age.
3. Nominee must be a resident of Indiana and reside in Blackford, Delaware, Fayette, Franklin, Grant, Henry, Jay, Madison, Randolph, Rush, Union, or Wayne county.
4. Previous recipients of the LifeStream Golden Hoosier Award are not eligible.
5. This form must be completed to qualify the nominee for the award. Additional sheets may be attached if needed. Please limit nominations to 3 per organization.
6. A selection committee representing LifeStream Services will select the top nominees and the LifeStream Golden Hoosier Award recipients.
7. The selection committee will also nominate individuals for special recognition by the Indiana Lieutenant Governor and Indiana Family and Social Services Administration.

Nominee Information

Nominee Name(Required)
Address(Required)
Please provide a detailed explanation.

Nominator Information

Nominated By:(Required)
Address(Required)

Follow us:

Contact Us

Transportation

Are you a ... ?

Newsletter

This field is for validation purposes and should be left unchanged.

QuestionPro provides unparalleled insights and just launched enterprise features including Communities, Customer ExperienceWorkforce and Mobile.

Copyright © LifeStream Services Inc. – All Rights Reserved.  |   Site Created by Intersection

Privacy/HIPAA/Quality

Skip to content