Nassau County, NY

Nassau County Office of Hispanic Affairs
Peruvian Independence Day Celebration Honoree Nomination Form

The nomination period has closed. Last day of nominations was Wednesday, July 21st, 2021. Thank you.

The Nassau County Office of Hispanic Affairs will host its Peruvian Independence Day Celebration on Wednesday, July 28th, 2021 at the Theodore Roosevelt Legislative and Executive Building.

The public is invited to nominate Peruvian-American individuals who have contributed and made a difference in Nassau County and who will be honored during our Peruvian Independence Day Celebration. All are invited to join us to honor the contributions and accomplishments of Peruvian Americans in Nassau County. Please email us at NCHispanicAffairs@nassaucountyny.gov to receive notifications of the event

All nominations must be completed and submitted by Wednesday, July 21st, 2021.

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

STEP 1 Nominee Information

Nominee must be a Nassau County Resident

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: