Organization:_________________________________________________

 Address:____________________________________________________

 City/State/Zip:________________________________________________

 Phone:________________________Fax:_________________________

NOMINATED BY:
 Name:______________________________________________________

 Organization:_________________________________________________

 Address:____________________________________________________

 City/State/Zip:________________________________________________

 Phone:________________________  Fax:_________________________

Please answer the following questions in the space below (if you need additional space, continue on the back.)  Submit no more than three news clippings about the nominee.  No resumes or reference letters, please.

1. Why is this person being nominated for this award?  Please detail the nominee’s personal and/or professional history, volunteer work, work with homeless people and homeless advocacy groups.
 
 
 
 

2. How does this person’s work exemplify the legacy left to us by Beverly “Ma” Curtis?
 
 
 

Please return this form (or a facsimile) to:  OCHH, 3896 Beverly Ave. NE, Bldg. J-6, Salem, OR  97305; FAX:  503-370-7630; or by Email to: OCHH@qwest.net   --RETURN BY MARCH 15, 2002