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2021 Jim "Doc" Wiley Leadership in the Arts Nomination Form

  1. Perpetual Plaque in Town Hall for the Jim "Doc' Wiley Leadership in the Arts Award
  2. INFORMATION ABOUT THE PERSON OR GROUP SUBMITTING THE NOMINATION
  3. Primary telephone number is (select one of the following):*
  4. Secondary telephone number is (select one of the following);
  5. INFORMATION ABOUT THE NOMINEE
  6. Write the name of the individual, organization, or business you are nominating.
  7. The nominee is:*
  8. Primary telephone number is (select one of the following):
  9. Secondary telephone number is (select one of the following):
  10. Upload at least one letter of support from another organization or individual. Use the additional two fields below if you are uploading more than one letter.
  11. You may submit up to five documents, photos, news articles, or other materials to support your nomination. Use the additional four fields below for if you are uploading more than one file.

  12. Leave This Blank:

  13. This field is not part of the form submission.