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Fred L. Burns Community Service Award

  1. Fred L. Burns Community Service Award Nomination Form

    Nomination period is midnight of January 1st to midnight of December 31st. Please use this form to nominate an exemplary individual for the Fred L. Burns Service Award. Nominees must be someone who has made a significant contribution to the Chino Valley Fire District in the area of furthering the District’s Mission Statement and who has made a significant contribution to the Chino Valley. The Mission of the Chino Valley Independent Fire District is to protect the lives and property of the community from the detrimental effects of fires, medical emergencies and other hazardous conditions.

  2. Please Check One:

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  4. (If applicable)

  5. References

    Please provide two references who are familiar with and can verify the scope and extent of the nominee's volunteer service activities. These people may not be the nominator, nominee, or a relative of the nominee. Please make the individuals aware they may be contacted.

  6. Reference #1

  7. Reference #2

  8. Nominations will be evaluated based on your answers to the questions below. Please be specific and detailed. All responses should be 500 characters of less

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