Nassau County, NY

Nassau County Office of Hispanic Affairs
Nominee Application for Hispanic Heritage Month

Nassau County will host its Annual Hispanic Heritage Month Celebration on Friday, October 15th, 2021 at 5:30pm

The public is invited to nominate Hispanic American residents who have contributed and made a difference in Nassau County. Please fill out all required fields and review the form before submitting. The Nassau County Office of Hispanic Affairs’ Cultural Planning Committee will use this form to evaluate the nominees and choose from all submissions. The selected honorees will be recognized at our Hispanic Heritage Month Celebration.

All are invited to join us in this event to honor the contributions and accomplishments of Hispanic-Americans in Nassau County. Please email us at NCHispanicAffairs@nassaucountyny.gov to receive notifications of the event.

Thank you for taking the time to complete the Hispanic Heritage Month Honoree Nomination Form.

All nominations must be completed and submitted by Friday, October 1st, 2021.

All fields marked with a red asterisk (*) are required.

STEP 1 Nominee Information

Name: *

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Phone Number: *

Email Address:

Employer:

STEP 2 Your Information

Name: *

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Phone Number: *

Email Address: *

STEP 3 Nominee Contributions

In your own words, please describe how your nominee has improved the well-being of the community:

STEP 4 Award Title

Please select the title of the award you would like your nominee to be considered for: