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Zones of Peace Nomination Form
Whose story of success and courage will you highlight?Zones of Peace is a region-wide interfaith movement of houses of worship, schools, and community-based organizations working to address the root causes of violence and promote peace in Greater Philadelphia. Zones of Peace communities understand that violence takes on many shapes—from poverty in our neighborhoods to bullying in our schools and fear in our homes. Recognized Zones of Peace seek unique ways to address the challenges most palpable in their neighborhoods. The initiative is facilitated by the Religious Leaders Council of Greater Philadelphia.
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Please contact Rev. Jay Gardner, Zones of Peace Coordinator for more information:
[email protected]
Nominated Organization Details
Name of Nominated Organization
*
Organization Address
*
Address Line 1
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Nominated Organization Website URL
Within the Organization, the appropriate person to be contacted by Zones of Peace is:
Salutation
Archbishop
Bishop
Cantor
Chaplain
Dr.
Elder
Fr.
Imam
Lt. Colonel
Major
Mr.
Mrs.
Ms.
Msgr.
President
Pastor
Prof.
Rabbi
Rev.
Rev. Dr.
Sheik
Sr.
The Most Reverend
The Rev. Canon
The Rt. Rev.
The Very Reverend
Venerable
Name
*
First
Last
Suffix
II III IV Jr. M.D. Ph.D. Ret. Sr.
CPA
D.D.S.
Esq.
II
III
IV
Jr.
M.D.
Ph.D.
R.N.
Ret.
Sr.
Role within Organization
*
Email
*
Home Phone
Work Phone
Cell Phone
*
Preferred Contact Method
*
Email
Phone
One paragraph description of nominated organization’s efforts to address violence and cultivate peace in their community:
*
Person Completing Nomination Form (You):
Salutation
Archbishop
Bishop
Cantor
Chaplain
Dr.
Elder
Fr.
Imam
Lt. Colonel
Major
Mr.
Mrs.
Ms.
Msgr.
President
Pastor
Prof.
Rabbi
Rev.
Rev. Dr.
Sheik
Sr.
The Most Reverend
The Rev. Canon
The Rt. Rev.
The Very Reverend
Venerable
Name
*
First
Last
Suffix
II III IV Jr. M.D. Ph.D. Ret. Sr.
CPA
D.D.S.
Esq.
II
III
IV
Jr.
M.D.
Ph.D.
R.N.
Ret.
Sr.
Relation to Organization (may not be paid staff):
*
Email
*
Home Phone
Work Phone
Cell Phone
*
Preferred Contact Method
*
Email
Phone
Submit
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