Date:

The Indiana Civil Rights Achievement Award is designed to honor an individual or a group for outstanding achievements in the planning and execution of Civil Rights activities within the Natural Resources Conservation Service agency and the community.

Please select the award this recommendation applies to:

AGENCY RELATED (One Only) COMMUNITY RELATED (One Only)

Group Group

Individual Individual

Please identify candidate(s) for individual and/or group recommendation (as indicated above):

Candidate(s) Name: Title: Work Location:

(Attach additional page[s] if needed)

Describe the agency or community activities that qualify the above candidate(s) for recommendation for this award? (Attach additional page[s] if necessary)

Contact Person: Phone: