Lovin' Scoopful Honors Youth

First Name

Middle Name/Initial (Optional)

Last Name

Street Address

City

State Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zip

E-Mail (required)

Phone

Date of Birth (Optional) Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2009 2009 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909

Your relationship to the nominee:

Org. Coach Org. Staff Parent Teacher School Admin Fellow Athlete Other If "Other" Please explain...

Organizational involvement of Nominator:

Special Olympics, involved as:
Coach Staff Volunteer Athlete

Unified Sports, involved as:
Coach Staff Volunteer Athlete

Best Buddies, involved as:
Staff Volunteer

Stop Bullying Campaigns

Other

First Name

Middle Name/Initial (Optional)

Last Name

Street Address

City

State Please Select Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zip

Parent/Guardian E-Mail

Parent/Guardian Name

Parent/Guardian Phone

Date of Birth (required) Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2009 2009 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909

Organizational Involvement of Nominee:

Special Olympics, involved as:
Volunteer Athlete

Unified Sports, involved as:
Volunteer Athlete

Best Buddies, involved as:
Volunteer Athlete

Stop Bullying Campaigns

Other

In 200 words or less, please describe how your nominee has served as a positive role model by promoting human rights, inclusion, and equality among students of all levels of intellectual development and has chosen to stand up for others or speak out against injustice and abuse.

[ Different Image ]

We will be contacting the Nominee directly and thru their parents will arrange media interviews of the winners.  By submitting, you are acknowledging that you understand that direct contact will be made.  As a nominator, you may also be contacted for an interview which you are not obligated to give.  A PR firm contracted by Lovin' Scoopful will handle most of the media contact.  Please direct any questions about this process to TamaraGordy@LovinBrands.com and we will get answers for you as soon as possible.