About You First NameRequired Last NameRequired Additional Nominator's Names Are there any other individuals who are accepting the responsibilities of Nominator with you? Provide their full names separated by commas, if multiple. EmailRequired PhoneRequired ###-###-#### Alternate Phone ###-###-#### Street AddressRequired CityRequired StateRequired Zip CodeRequired Time Known FamilyRequired Less than 1 Year1 to 3 Years4 or More Years Your Relationship to the FamilyRequired Close FriendNeighborSame HouseholdCo-WorkerTeacherFamilyCommunity LeaderNo RelationshipOther Relationship Problems? Please check above for error messages and then contact us.