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Youth Meritorious Award Nomination Form

Name of Nominee *

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Last

Nominee Address

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Address Line 2

City

State

Zip Code

Nominee Phone Number

Nominee Email *

School Name: *

School Address: *

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Address Line 2

City

State

Zip Code

Nominated by: *

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Last

Nominator Address *

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Address Line 2

City

State

Zip Code

Nominator Phone Number *

Nominator Email *

Parent/Guardian *

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Last

Parent/Guardian Address

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Address Line 2

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State

Zip Code

Parent/Guardian Phone

Provide details of the nominee's scholastic achievements, leadership qualities, community services and/or other characteristics and contributions. *

Name

Grant Management

Washington County Administration Complex

100 West Washington Street
Hagerstown, MD 21740
Suite 2200

Office Hours: Monday-Friday, 7:30 a.m. – 4:30 p.m.
Phone: (240) 313-2040
Fax: (240) 313-2041

TTY users may call any government office through the Maryland Relay Service
1-800-735-2258

Grant Management

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