Lowenstein Trust

Recognizing those who are making a difference for the underserved

NOMINATION FOR THE LOWENSTEIN TRUST AWARD


Date:
NAME OF NOMINEE:
Address::
City:
State: Zip Code:
Work Phone:____________ Home Phone:____________ Email:____________


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1- Please describe this person's contribution to assisting the poor and underprivileged in Portland, OR.
 

 

2- Explain how you think this award could assist the nominee in carrying on his or her work.

 


3- What inspired you to nominate this person?

 

 

Please provide the names and contact information for two references familiar with the nominee’s activities:
Reference 1:
Name:
Work Phone:___________ Home Phone: ___________ Email:___________

Reference 2:
Name:
Work Phone: ___________ Home Phone:____________ Email:___________

YOUR name, address, phone number, e-mail:
Name:
Address:
City: State: Zip Code:
Work Phone:___________ Home Phone_____________ Email:
___________

Download and mail /fax/email completed form
(DUE October 27th, 2017) to :
Lowenstein Trust, c/o Kris Wilkinson | 6927 N. Oatman |
Portland, Oregon 97217 |
Phone: 503-283.5210 |
Email - Support@lowensteintrust.org (
Please put : Lowenstein Award Nomination in the Subject line)

This form may be copy/pasted into a word processing application, or email message, for completion and submission.