The nominee's work with or for youth may be in the context of religious education, public education, Scouting, or other youth programs. Nominees must be members of Pagan or other Nature-oriented religions. Individuals may not nominate themselves.

Nominee's name	____________________________________________________________
I hereby nominate this person to receive the Hart and Crescent Distinguished Youth Service Award. I attach a letter describing the nominee's work on behalf of youth, and explaining why we feel s/he deserves special recognition.
Nominator's signature	____________________________________________________________
Organization represented	____________________________________________________________
Date	____________________________________________________________
Relationship to nominee (Priest/ess, coven elder, etc.)	____________________________________________________________
Name and address where award should be sent	____________________________________________________________ ____________________________________________________________ ____________________________________________________________

Enclose a fee of $15.00, in the form of a check or money order payable to the Covenant of the Goddess, and mail to:

C.O.G./Hart and Crescent
P.O. Box 1226
Berkeley, CA 94704

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