Erie County Historical Society
2012 Local History & Historic Preservation Awards
Nomination Application
Name of Individual Submitting Form: ________________________________
Mailing Address: ___________________________________________
Telephone No.: (Day) _________________(Evening) ___________________
Nominee: _________________________________________________
(Individual, Group, Building or Project)
Nominee’s Address: ___________________________________________
Nominee’s Telephone No:(Day) ______________(Evening) _______________
Property Owner’s Signature: ______________________________________
(Preservation Award Only)
Check the appropriate award category:
Preservation Awards Local History Awards
⃞ Preservation Stewardship ⃞ Education Award
⃞ Construction Project ⃞ Student Award
⃞ Enhancement Project ⃞ Local History Award
⃞ Preservation Initiative ⃞ Media Award
If you are nominating for a preservation award, do you consider the project to be (check one):
⃞ Preservation ⃞ Rehabilitation ⃞Restoration
Date the project was completed:__________________________
Nomination Criteria
- Briefly describe the project or activity for which the individual or organization is being nominated. The summary should be no more than two typed pages.
- Please include, if applicable, any samples of audiotape or videotape, slides, photographs, or other documentation to substantiate the nomination. If nominating for a preservation award, please include before and after photographs.
The Awards Committee will not consider a nomination form complete without the project description outlined in Nomination Criteria #1. All supporting data should accompany the nomination form.
Please return all forms no later than May 1, 2012 to:
Erie County Historical Society
419 State St.
Erie, PA 16501
