2009 Nomination Form

York Suburban Communities That Care Alliance

Cathy Shaffer Award of Honor 2009 Nomination Form York Suburban Communities That Care Alliance strives to provide researchbased tools to help our community promote the positive development of children and youth, prevent adolescent substance abuse, and reduce youth violence. Cathy Shaffer was instrumental in the formation of YS CTC Alliance and served as the first president of the Board of Directors. Her dedication and commitment led this organization to a position that has allowed us to touch many lives within the York Suburban community. YS CTC seeks to honor these efforts by honoring students who, through their actions and words, demonstrate and promote the values of YS CTC Alliance. Awards will be presented at the Middle School and High School awards ceremonies. The following shall be the criteria upon which nominations will be judged: A nominee shall • promote the values of YS Communities That Care • be a strong role model • be involved in the community • be a student in grades 6-12 • be a resident of York Suburban School District

Do you know a student who is making this kind of positive contribution to our community? Nominee’s Name_______________________________________________________________________ Address ________________________________________________________________________ Phone # ____________________ Grade _____________ Nominator’s Name _____________________________________________________________________ Address ________________________________________________________________________ Phone # ____________________ Relationship to Nominee ______________________________

Please explain clearly, in detail, how this student has demonstrated the values of YS CTC and has acted as a strong role model for others in our community. Use the reverse side or additional sheet as necessary to give a complete description.

All nominations MUST be received by April 15, 2009. Please return this form to: Shama Mir YS CTC Alliance 1800 Hollywood Drive York, PA 17403

York Suburban Communities That Care Alliance connects families and youth with effective resources that promote responsible decision-making and reduce destructive behaviors.