BROCKTON'S PROMISE/THE ALLIANCE FOR YOUTH
The Caring Adults Team of Brockton’s Promise invites you to nominate an adult who has made a difference by being an exceptional mentor. Mentoring includes formal relationships through a program (i.e. Big Sister Big Brother) as well as the informal relationships that happen every day (i.e. a caring neighbor, a teacher, a person at church, a friend’s parent, etc.). One selected mentor will receive an award during our 3rd Annual Mentor Recruitment Rally on January 27, 2011 from 5:30 – 8:00pm at the Shaw’s Center in Brockton. Young people ages 24 years and younger are encouraged to submit nominations.
1) Your Name (Nominator): _____________________________________________________
2) Your Phone Number & E-mail Address:__________________________________________
3) Mentor’s Name (Nominee): ___________________________________________________
4) Mentor’s Address:__________________________________________________________
Street City/Town Zip __________________________________________________________
5) Mentor’s Phone Number & E-mail Address: ______________________________________Scoring Criteria: Has mentored a young person for at least 1 year
Regularly meets with the young person to maintain consistent contact
Displays behavior worthy of a role model (i.e. is courteous and respectful of others)
Demonstrates respect for the young person’s thoughts, feelings and decisions
Helps build the young person’s self-confidence
Exposes young person to new experiences In 500 words or less, please describe how your nominee meets the criteria listed above. Typed or neatly handwritten submissions are accepted.
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______________________________________________________________________________(Use the back for additional space or attach a separate sheet)
Return Form by December 17, 2010 to: Amanda Trask, Plymouth County DA’s Office, 32 Belmont Street, Brockton, MA 02301; Email: amanda.trask@state.ma.us; Fax: 508-586-3578
PROMISE IN ACTION AWARD FOR AN EXCEPTIONAL MENTOR
NOMINATION FORM
