Community Champion Nomination Form


Please note that all fields are required. Community Champion Nominee Name: What category does your nominee best fall into?: Police Officer Fire Fighter Teacher Medical Professional Business Person Student Senior Citizen Coach Individual	NOMINEE'S INFORMATION Nominee's Address: Nominee's Telephone Number: Nominee's Business or Organization: _______________________________________________ NOMINATOR'S INFORMATION Nominator's Name: Nominator's Email: Nominator's Telephone Number: Nominator's Address:
How has this individual made a difference? (You may add attachments of nominee's photograph or any supporting documentation of nominee's efforts. If mailing, please attach documents to this completed form.)
Add Attachments:

Eligibility Requirements / Information: Nominees' involvement or actions must have taken place in Southeastern CT. Nominees can be self-nominated or nominated by others. Nominees and Nominators are not restricted to Chelsea Groton Bank customers. Community Champions are chosen on a monthly basis. Each Community Champion will have a $250 donation in their name made to a locally recognized 501C3 organization of their choice. Community Champions will also be featured on Chelsea Groton Bank's web site. For questions regarding this program, please contact Tom Kasprzak, Vice President, Director of Marketing, at 860-448-4115 or tkasprzak@chelseagroton.com. If mailing, please send to: Chelsea Groton Bank, Customer Relations Dept., 904 Poquonnock Road, Groton, CT 06340. Member FDIC