JOHN H. MATHIS TRAILBLAZER AWARD
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NOMINEE'S INFORMATION
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| Contact Person, if organization/group: | |
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Category of organization/group, if applicable (i.e. community group, business, etc.) |
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| Daytime phone: | |
| Evening phone: | |
| Address: | |
| City/Zip: |
NOMINATOR'S INFORMATION
| Nominator's Name: | |
| Daytime phone: | |
| Evening phone: | |
| Address: | |
| City/Zip: | |
| Nominator's Signature: | |
| Date: |
Please describe on a separate typewritten page the unique nature of the nominee's contribution to the state of Delaware. What was accomplished? How was it accomplished? How has it impacted diversity and cultural understanding?
Attach additional pages if necessary. Additional relevant information, for example letters of support, newspaper clippings, photographs, etc. may be included with the nomination form.
Thank you for your nomination! We appreciate you taking the time to recognize your nominee and we will give this package our careful attention.
Mail nomination form to:
Trudy Mifflin
Office of Management and Budget
122 William Penn Street
Suite 101, 1st Floor
Haslet Building
Dover, DE 19901
Or fax with cover sheet to: Trudy Mifflin at (302) 739-1181.
