CITY OF POMONA
NOMINATION FORM FOR NAMING OF
PARK AND RECREATION FACILITIES
1. D
ate Submitted: ___________________________________________________________
2. N ominator Name: __________________________________________________________
3. Address: __________________________________________________________________
4. Phone (daytime): ___________________ (evening or cell): ________________________
5. What Group (if any) does the Nominator represent?: ____________________________
6. Recommended Site & Location: _____________________________________________ ____________________________________________________________________________
7. Recommended Name: _____________________________________________________
8. What is Nominator’ s relationship to Individual or Group Recommended for Name? __________________________________________________________________________
9. P lease discuss the reason for this nomination as it relates to criteria in Policy (additional supportive information, photos, or articles may be attached):
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
10. Community-wide activities Individual or Group is involved in: _____________________ ______________________________________________________________________________ ______________________________________________________________________________ _________________________________
_____________________________________________
Attachment No. 2
NOMINATION FORM FOR NAMING OF
PARK AND RECREATION FACILITIES (Page Two)
11. Local Clubs or organizations served: ___________________________________________
______________________________________________________________________________
______________________________________________________________________________
12. If an Individual, name(s) of Schools attended: : __________________________________
______________________________________________________________________________
13. Major benefits to the City of Pomona: __________________________________________
______________________________________________________________________________
______________________________________________________________________________
14. Why are you nominating this Individual or Group? ______________________________
______________________________________________________________________________
______________________________________________________________________________
Submit Form to: Community Services Department
P.O. Box 660
Pomona, CA 91769
(909) 620-2321
I have received a copy of the Policy for Naming of Park and Recreation Facilities and this nomination adheres to the criteria as outlined in the Policy. The statements contained within this document are true, to the best of my knowledge.
_____________________________________ Dated: ____________________ Signature of Nominator