Community Changemaker Application

For any questions, feel free to contact: info@bgtogether.org or (816)663-9794

Uploading Video Instructions Here

Candidate’s First and Last Name

(including other names known by)

First Name

Last Name

Candidate’s Initiative or Organization

Candidate’s E-mail Address

Candidate’s Mobile Number

(###)

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Address/es for Candidate’s Initiative or Organization

(can be a home or PO Box, if no physical office address exists)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Address/es continued

(if necessary)

Nominator’s Contact Information

(If different than the candidate)

Nominator’s E-mail Address

Nominator’s Mobile Number

(###)

###

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Description of your relationship with or knowledge of the Candidate and the length of time of your relationship

(if you are not nominating yourself)

If appropriate, please provide the names and contact information of others with additional, deeper knowledge and information about the candidate and their work

Statement of why you believe the candidate meets the selection criteria, including the specific qualities and accomplishments that align with BeGreat Together.

You should certainly explain what the candidate has done to demonstrate vision and commitment to improving the lives of others especially individuals and communities in need or disadvantaged.

Video Link

Youtube Link to your “unlisted” video (instructions linked at the top of application)

http://