Form Center

2. 1. Information of individual or organization submitting the nomination.
4. Name:*
6. Organization:
8. Address:
9. City:
10. State:
12. Zip Code:
13. Phone Number
15. Email:
17. 2. Information of individual or organization being nominated.
19. Name
21. Organization:
23. Address:
24. City:
25. State:
27. Zip Code:
28. Phone Number:
30. Email:
32. Criteria for selection

    • The nominee performed, created, or developed an activity and/or public service (volunteer or other) that positively enhanced and/or impacted the City of Cudahy; or

    • The nominee contributed to the community through an act, achievement or service that directly or indirectly advanced the opportunities and/or benefited others in Cudahy; or

    • The nominee has demonstrated a clear commitment and/or civic pride by performing an outstanding act or achievement or by rendering distinguished service to the improvement of Cudahy; and

    • The nominee is a stakeholder, child/dependent of a stakeholder, or a student enrolled in a school within the boundaries of the Cudahy and

    • The nominee is NOT an active Cudahy council member or a member of the immediate family of active Cudahy council member.

34. 3. Based on the criteria above, please briefly describe why you are nominating this person(s) to be recognized by the City council.
36. 4. Please list two references (with contact information) not related to you or the nominee who can verify the above information:
38. Reference 1:
39. Reference 2:
41. Contact Info:
42. Contact Info:
44. Please return your application to the Parks and Recreation office through:

    Email: brodriguez@cityofcudahyca.gov or

    4835 Clara Street, Cudahy Ca 90201

Leave This Blank:


46. Submit

* indicates a required field