2024 Wertheimer Youth in Action Award Nomination

Please complete this form in its entirety if you wish to nominate a community youth volunteer under the age of 18 for the 2024 Wertheimer Youth in Action Award. All nomination forms must be submitted by May 31, 2024. Please note that this form will not allow you to save and return later to continue working, you must input all information at the time of submission. You will receive a confirmation email when the form is submitted. If you have any questions, please contact our office at 301.695.7660. Thank you!

Name of Nominee(Required)
Address of Nominee(Required)
Name of Nominee's Parent or Legal Guardian(Required)
Address of Nominee's Parent or Legal Guardian(Required)
Name of person nominating volunteer(Required)
Address of person nominating volunteer(Required)