Dora Maxwell Award Entry Form

Entry Form for The Dora Maxwell Social Responsibility Award

Contact Person___________________________________

Title_____________________________________________

E-mail Address____________________________________

Credit Union Name_________________________________

Street Address____________________________________

P.O. Box_________________________________________

City___________________ State______ Zip___________

Asset size: __ Less than $5 million __ $5 - $20 million __ $20 - $50 million
__ $50 - $100 million __$100 - $200 million __$200 - $500 million
__ $500 million+ __ Chapter

Credit Union's field of membership: ______________________________________
Number of credit union branches: _________
Number of credit union members:__________
Number of credit union employees: _________
Number of credit union employees responsible for implementing the project:________

Please include significant promotional materials, descriptions, and photos of projects/events with your entry.
Submit materials in a three-ring binder or spiral bound notebook
Electronic media is not encouraged

Answer the following questions (use additional paper if necessary)

1. If your credit union was involved in multiple projects, please list them here. If not, proceed to question 2.

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2. Select and describe the one project that was the most successful and the most unique -- the one that best exemplifies the Dora Maxwell Social Responsibility Recognition Award. (The ensuing questions must be answered based on this one project.)

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3. What were the goals of your project and how did they show social concern for the community? (Include measurable goals such as dollars budgeted, number of people impacted, etc.)

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4. How did the project support the needs of the community?

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5. Define the project's target audience(s), including who got involved and who benefited from the project.

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6. What strategies were used to reach the project's goals?___________________________________________

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7. How were the project's promotional materials targeted to the intended audience(s) and how did they communicate the project's goals?

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8. How is the project unique? How does it demonstrate extraordinary effort and devotion of time and organization by the credit union?

________________________________________________

9. Please describe the measurable or defined results the project achieved.

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10. How does the project demonstrate credit union values of mutual self-help, cooperation, economic empowerment and volunteerism?

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You must also include a completed checklist with your entry form.

For more information, please contact William Wille, Public Relations Specialist, at (800) 942-7124, ext. 3216.