City of Newburgh - Human Rights Commission
Human Rights Hero Nomination Form
NOMINATION MATERIALS MUST BE RECEIVED NO LATER THAN4:00 PM, FRIDAY, NOVEMBER 1, 2024.
First Name of Nominee
Last Name of Nominee
Email address of Nominee
Phone number of Nominee
Residence Address of Nominee
Mailing Address (if different from Residence)
Birthdate of Nominee
Nominator information: Please enter your own information here.
Your name
Email address
Phone number
In what capacity do you know the nominee?
What organization is the nominee affiliated with (If any)?
Nominee Education: (schools/degrees/specialties)
Tell us about the Nominee. Provide a short factual description of the nominee including: brief career background, description of current organization (if any) and what type of human rights work they do.
Describe why this Nominee should be a City of Newburgh Human Rights Hero? Include the Nominee’s role and contribution to the human rights movement.
Please submit or attach the following:
Humanitarian Service History no more than three pages
Any other information you believe would be relevant
Upload Humanitarian Service History (no more than three pages):
Upload other relevant documents:
TRANSPARENCY
Let us know if you or your nominee has an affiliation with the City of Newburgh. This is for transparency only; the panel will review your application without bias. Read our full Conflict of Interest policy (https://ecode360.com/10870568 ).
Confirmation and Consent affirmation – I, the nominator, attest to the following:
The information to be true to the best of my knowledge. Nominee consents to being nominated.
