Adult     Youth     Organization  
 
 
 
  I.  IDENTIFYING INFORMATION
 
      A) Nominee's Information
 
Name or Name of Organization Mailing Address
 
City State Zip Phone
 
      B) Nominating Individual
 
Name Phone  
 
 
  II.  NARRATIVE INFORMATION:
 
       A) List the accomplishments and activities during the past
           year that make this individual/organization deserving of recognition:
 
          
 
       B) List any additional information about the Nominee's
           activities during the past year which you feel would
           be pertinent in honoring this individual/organization:
 
          
 
If you would like to send attachments regarding this nomination, please mail them to Leadership Texarkana, 604 Walnut Street, Texarkana, Arkansas 71854. Please reference the Wilbur Award and your nominee's name.