Cultural Fellowship Nomination Form

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The Chalfonte Foundation is currently seeking nominations for our 2020 Cultural Fellowship Program. The Fellowship includes cultural, agriculture, and service activities throughout the year. All expenses associated with the fellowship including travel, museum admissions, concert tickets, and meals are sponsored by the Chalfonte Foundation.

Mentors, coaches, parents, or any other adult role model is eligible to nominate youth between the ages of 12 and 18. Nominees must be residents of Wayne, Oakland, Macomb, Clare or Antrim counties. If you would like to nominate someone please complete this form and submit to the Foundation by February 1, 2020.

Nominee's Name *

Birthday *

YYYY

County of Residence *

Wayne

Oakland

Macomb

Clare

Antrim

Other:

What is the name of the school the Nominee attends (If home school please note that) ? *

When does school start *

YYYY

When Does school end? *

YYYY

Why do you believe the nominee is good fit? *

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