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Community Impact & Leadership

Recognizing Agents of Change and Community Builders

Description
Nomination Form

This award honors Black individuals making a difference through grassroots efforts, organizing, or nonprofit work that empowers and uplifts communities. Who Should You Nominate? Nominate someone who:

Has founded or leads a nonprofit or community program
Advocates for systemic change or empowerment
Is deeply engaged in community building

What Makes a Nominee Stand Out?

Visionary leadership and dedication
Measurable impact on local or state level
Recognized by peers or the community

Include in Your Nomination:

Overview of their work and impact
Programs or initiatives they’ve led
Testimonials or press coverage

Back to Nomination Categories

Complete the Nomination From Here

General Nomination Form

Nominee Information

Nominee Name

Nominee Email

Nominee Phone Number

Nominee Address

Nominee Narrative
*not to exceed 2000 characters.

How has the nominee demonstrated exceptional service, courage, or leadership in their role as a first responder?

Describe an incident, action, or ongoing contribution where the nominee significantly impacted public safety, emergency response, or community wellbeing.

What lasting impact has the nominee made on their department, community, or the individuals they have served?

How has the nominee inspired, mentored, or supported youth development?

What measurable outcomes (e.g., graduation rates, leadership growth) have resulted?

How does the nominee foster spiritual growth, healing, or interfaith dialogue?

Describe their role in community resilience or moral leadership?

What artistic or cultural contributions has the nominee made?

How has their work preserved heritage, sparked dialogue, or uplifted marginalized voices?

How has the nominee advanced learning, equity, or student success?

Include examples of curriculum innovation, mentorship, or advocacy?

What outstanding athletic accomplishments or contributions has the nominee made in their sport or field?

Describe how the nominee has demonstrated discipline, leadership, teamwork, or positive representation of their community.

What lasting impact has the nominee made through mentorship, coaching, community involvement, or athletic excellence?

How has the nominee demonstrated outstanding civic or governmental leadership in service to the public?

Describe policies, initiatives, or programs the nominee has championed that improved the lives of residents or strengthened civic engagement.

What long term or measurable outcomes reflect the nominee's leadership and public impact?

How has the nominee's small business contributed to economic growth, job creation, or community enrichment?

Describe key achievements such as innovation, growth milestones, customer service excellence, or community involvement.

What challenges has the business overcome, and how has the nominee demonstrated resilience or leadership?

How has the nominee guided a large business or organization to make a significant impact at the regional or state level?

Describe major achievements such as expansion, innovation, workforce development, or industry leadership.

In what ways has the organization demonstrated social responsibility or contributed to statewide progress?

How has the nominee demonstrated exceptional leadership within their community?

Describe specific initiatives, programs, or actions that have improved the wellbeing or unity of the community.

What measurable or visible outcomes show the nominee's lasting impact on the community?

Nomination Evaluation

Evaluation Instructions: Nominees are scored on the following criteria. When writing your narrative, provide as much detail as you can for each, and include any additional accomplishments or context that may not be listed.

Impact & Reach - Describe the nominee's influence and impact on their community, field, or state. Include specific examples of how their work has affected others and the scope of their influence.
Leadership Initiative - Provide examples of the nominee's leadership qualities, innovative approaches, or initiatives they have taken. Describe how they have led others or pioneered new solutions.
Alignment with Category - Explain how the nominee's achievements and contributions specifically relate to and exemplify the chosen nomination category.
Community Endorsement - Describe any awards, recognition, testimonials, or support the nominee has received from their peers, community, or relevant organizations.
Legacy & Sustainability - Explain how the nominee's contributions will continue to benefit others in the future and the lasting impact of their work.

Nominator Information

Your Name

Your Email

Your Phone Number

Your Relationship to Nominee

Additional Comments (optional)

Community Impact & Leadership

Recognizing Agents of Change and Community Builders

Description

Nomination Form

Complete the Nomination From Here

Nominee Information

Nomination Evaluation

Nominator Information

Our Commitment to Black Excellence in Washington State