Smiles for Seniors Umbrella Awards Nomination Form
 Do you know someone who is always doing something nice for you or for others?
Someone who goes out of their way to help a stranger, gives the shirt off their back, Lends a hand?  
We are looking for great stories about those special people who do extraordinary things for others.
Nominees will receive a dinner ticket and a special award at the event May 14th just for being nominated.
Submit your entries by mailing or emailing 200 words or less about the person you wish to nominate to Smiles 4 Seniors "Umbrella" P.O. Box 1113 Yucaipa Ca 92399 or email at
Categories and Examples are:
Public Service- First Responders, Fire, Police, Nurse, Teacher 
Good Samaritan-  Any one person who does good deeds

Non Profit Organization- Church, Charity, Non Profit Organization
Business- Responsible companies who give back to the community
Nominated By____________________________________________________________________________________

YOUR Phone ______________________________YOUR Address___________________________________________
Nominee Name____________________________________________________________Catagory__________________________

Nominee Phone________________________________________

Nominee Address________________________________________________________

Nominations must be received by April 25th 2022 
Nominations must be received by 04/25/2022 Umbrella Award winners will be chosen by an outside panel of judges who will determine one winner in each category. Nominees and nominators names, stories and photos may be used in the media and on the Smiles for Seniors website. Nominees and their nominators will be notified by mail. All nominees will receive an award. Winning nominee will be announced at the award show. You do not have to be a senior to nominate, win, or attend the awards dinner. Children under the age of 18 must be accompanied by an adult,. Group party tables are available All proceeds will benefit local low income seniors in need. Please visit our website at or call (909) 790-6671 for more info. Smiles for Seniors may update the rules as needed