Application - Gwinnett | Gwinnett County

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Community Champion Application Form

Community Champion
2025 Candidate Nomination Form

All fields are required.

Please complete and submit a separate form for each individual.

Nominator Information

Last Name:

First Name:

Street Address

Apt / Suite / Other

City

State

Zip Code

Telephone

Mobilephone

Email Address :

Candidate Identifying Information

Last Name:

First Name:

Street Address

Apt / Suite / Other

City

State

Zip Code

Place of Employment

Occupation

Phone Number

Why do you believe this candidate should be recognized as a Community Champion?

Please describe in detail the great things your nominee has done in the community that is deserving of recognition as a Community Champion.