Community Collaboration Award

In recognition of entities that work together

for the benefit of Summit County

COLLABORATION: working together to support collective goals and attain a shared vision which was identified together; sharing people and resources; co-laboring

Nomination Form

Please list below the names of all collaborative partners, their mailing addresses, telephone numbers, fax numbers, and name of contact person for each organization.

Nomination submitted by: (Please include your name, mailing address, phone and fax.)

I. Please describe the project in 50 words or less. Include why these collaborative partnerships were formed, who was served by the project and what are the outcomes of the project. Also include the number of people served, the geographic area(s) served and the project’s expected end date.

II. Explain how the project contributes to a healthier community. A healthy community has a clean, safe, high quality environment and a sustainable ecosystem; provision of basic needs; appropriate, high quality, accessible health care services; quality educational opportunity; and a diverse, vital and innovative economy. In a healthy community, local residents participate in governance, understand and act upon whole systems and underlying causes, use collaborative and asset based approaches to problem solving, and seek out the voices and participation of individuals that reflect the diversity of the community. Explain how this project contributes to a healthy community in Summit County today and in the future.

III. Explain how the project fits the following criteria: 1. Two or more entities working together to improve provision of services and/or to reduce duplication of services and benefits. 2. Is cost-effective. 3. Encourages diversity.

PLEASE MAIL TO SHAPING OUR SUMMIT, P.O. BOX 1829, DILLON, CO 80435,

FAX TO 513-8348, OR EMAIL TO sos@merid.org

DUE FRIDAY, MAY18, 2001