OUTSTANDING CITIZEN AWARD CRITERIA AND NOMINATION FORM

CRITERIA

The recipient shall be a resident of the Ponca City area and a member of the Ponca City Area Chamber of Commerce.

The recipient should have achieved significant and general recognition as an outstanding community leader over a period of time, not limited to the year in which the award is made.

The recipient should be recognized as having made significant contributions to the community in more than one area of endeavor; such as, Chamber of Commerce, city volunteer activities, charitable organizations, business efforts and others.

The current chair and staff of the Chamber of Commerce, elected public officials including City, County, State or Federal will not be considered for selection.

* Indicates required field

Nominee

Nominee Name (First & Last) *

Chamber Membership Name *

Nominee Mailing Address *

Nominee Date of Birth *

Nominee Email *

Nominee Spouse's Name *

Number of Children & Ages *

Name and Address of Three Personal References:

Reference #1 *

Reference #2 *

Reference #3 *

Significant Contributions To The General Community Welfare And Development Of The City Of Ponca City.

Honors:

PLEASE LIST ALL HONORS: *

Activities:

ACTIVITIES 1. Civic Organizations (Jaycees, Rotary, Kiwanis, Lions, etc.) 2. Charitable Organizations (United Way and other non-profit organizations) 3. Other (such as church, youth organizations, etc.) *

EVIDENCE OF LEADERSHIP ABILITY (indicate present and prior years.) (Any other information that would aid the nominee or any information that would not go into the above area.)

Comment *

Nominator

PLEASE SIGN YOUR NAME *

NOMINATIONS MUST BE RECEIVED AT THE PONCA CITY AREA CHAMBER OF COMMERCE OFFICE, 420 EAST GRAND, P.O. BOX 1109, PONCA CITY, OK 74602 BY TUESDAY, DECEMBER 2, 2025