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2. 
4. Human Relations Committee
   Humanitarian Award Nomination Form

6. The Bismarck Human Relations Committee is seeking a youth, adult, and business or non-profit organization that has exhibited leadership in the area of human rights. We want to recognize people that educate, identify, protect and promote personal dignity with a focus on eliminating discriminatory barriers that would prevent people from reaching their full human potential.

8. Nomination Type*
   -- Select One --Individual (Youth)Individual (Adult)Business / Organization

   Please select the type of nomination you are submitting.

10. Name of Nominee / Name of Organization:*
12. Name of Nominee Parent or Guardian (Youth Individual Nomination Only):
14. Parent/Guardian Phone No.:
15. Parent/Guardian Email:
17. Occupation (Adult Individual Nomination Only):
19. CEO/Executive Director (Business/Organization Nomination Only):
21. Nominee Address:
23. City
24. State
25. Zip
27. Nominee Phone Number:*
28. Nominee Email Address:
30. Please tell us about your chosen nominee.*
    Please tell us about your chosen nominee. Specifically, how the nominee demonstrates leadership and helps to educate others in the areas of human rights. Please attach a separate document if you require additional space other than what is provided.
32. Additional documentation:
36. Name of Individual Making the Nomination:*
37. Phone Number:*
39. Email Address:*
43. Printed Nominations Can Also Be Mailed To:
45. City of Bismarck
47. Administration Department
49. 221 N. 5th Street
51. Bismarck, ND 58501
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field