HOBY OYA Award Nomination Form

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1 HOBY OYA Award Nomination Form The HOBY Outstanding Young Alumni Award was created to recognize and honor HOBY alumni, ages 25 and under for their accomplishments and service. The winners of the award have distinguished themselves as a leader among their peers and in their community. They have served in their schools, neighborhoods and communities, started their own non-profits and have made a significant difference in the lives of others. Award criteria: HOBY Alumni, who has participated in at least one HOBY program: State Leadership Seminar, CLeW, World Leadership Congress, Advanced Leadership Academy or an International Trip. Have upheld the core values of HOBY by displaying excellence, integrity, diversity, and innovative thinking. Through their service and leadership, they represent an example to their peers of an Outstanding HOBY Ambassador. They have served in their schools, neighborhoods and communities and have made a significant difference in the lives of others. Nomination form received by January 6, All applications will be reviewed by HOBY staff. Two winners will be selected to receive this award at the Albert Schweitzer Awards dinner in NYC or Los Angeles* *decided by HOBY. Two winners will be notified by January 31, 2014 via . Up to 25 Semi-finalists will receive a special certificate, pin and HOBY recognition on our website.** Anyone may nominate an alumnus or you may nominate yourself. Eligible alumni must be younger than 25 by May 5, All information must be verifiable. Winners must have completed a minimum of 100 hours of service and logged hours in the Leadership for Service system at hoby.org. To Apply Complete the cover information by the deadline of Monday, January 6, 2014.

2 Use up to one additional page to answer questions and support your responses. Semifinalists (up to 25) will be asked to submit 2 high resolution photos, a video and a brief quote ** Semi-Finalists are required to send a 1 minute video documenting their current project/hoby Story. More information on video will be sent via . Prize: Trip for two to either New York or Los Angeles including travel (airfare if applicable) and one night hotel accommodations. (Airfare not to exceed $500 per ticket). Award dinner is determined by HOBY upon announcement. Additional costs including food, additional transportation, airfare above $500 per ticket or other costs incurred are the responsibility of the winner. Four tickets to the Albert Schweitzer Awards Dinner (value: $2000). Ticket does include honoree. Honorees are expected to prepare a 2 minute acceptance speech at the awards dinner. $500 cash to be used either toward a college/university tuition or to donate to a non-profit of their choice.

3 HOBY OYA AWARD Please complete the form below and to with the subject line "Outstanding Young Alumni NAME in the subject line or fax: Information for Nominee: First Name: Last Name: Address: City: State: Zip: Phone: HOBY Alumni State: Year: Current Age: Community Service Hours completed and logged on HOBY.org: (Note: a minimum of 100 logged hours is required for consideration) High School: College: Company: Title: Parent/Guardian (required if under the age of 18) First Name: Phone: Last Name: By checking this box, I agree as the parent/guardian to have the above nominee accept the terms of the award. Name of person who is nominating alumni: First Name: Last Name: Phone:

4 Relationship to Nominee: Please complete the questions below in the space provided: Why is this nominee deserving of the HOBY Outstanding Young Alumni Award? What makes them deserving above other candidates? As a result of their time in HOBY, what need has the nominee identified in their community and how have they applied their leadership skills to address that need? As a result of their HOBY experience, how has this nominee inspired and/or improved the lives of others, their community or their cause?

5 Please list the any groups, clubs or non-profits that the candidate has created, organized or been a key volunteer with. Explain the involvement and impact on the school, community or area. How has the HOBY program impacted the candidate? Please include a quote from the nominee if possible. Is there additional comment/information you would like to share?