“Jewels of the Gem City” Nomination Form

A nominee for the “Jewels of the Gem City” may be an individual/couple, a company/corporation or an organization that has made a significant contribution to the historic preservation of Dayton either through financial, educational, cultural, promotional, or restorative contributions. Complete this form as indicated and send 5 copies to: Jewels of the Gem City, % Anne Stoops, Treasurer, 52 Ivanhoe, Dayton, OH 45419. Please do not send letters of support as ONLY this application will be considered by the panel of judges. All nominations must be received by March 1, 2011. Awards will be given on June 3, 2011.
This award is sponsored by The Woman’s Club of Dayton Foundation, The Engineers Club of Dayton Foundation and The Friends of the Dayton Arcade.


Section A – Nominee Information:

Name of Nominee:_____________________________________________________________________

Address of Nominee:___________________________________________________________________

City:________________________________ State:____________________ Zip:____________________

Contact Info: Phone(s):______________________________________ Fax:______________________
(Home) (Cell)
E-mail:_________________________________Web-site:______________________________________


Section B – Nominator information:

Name of person(s) making nomination:____________________________________________________

Address :_____________________________________________________________________________

City:________________________________ State:____________________ Zip:____________________

Contact Info: Phone(s):______________________________________ Fax:______________________
(Home) (Cell)
E-mail:_________________________________Web-site:______________________________________

Relationship to Nominee:________________________________________________________________



Section C – Nominee Qualifications: Using the following topics, please state why the nominee should be recognized as a “Jewel of the Gem City”. Please attach no more than 2 typewritten pages using 12 point or larger type. Please do not send any supporting documents.

1. Specific contribution(s) of the nominee to historic preservation in Dayton

2. Community volunteer work toward historic preservation in Dayton

3. Awards or honors received for Dayton community work

4. Pertinent educational or professional background information (if applicable)

5. Additional comments (not required)


Additional forms are available on the Engineers Club of Dayton website: www.engineersclub.com and at the bottom of this page. The 5 copies of this nominating form must be received by
March 1, 2011.