Fred L. Burns Award Nomination

Nominee's Information

Please provide contact information for the person you are nominating.

Nominee's Name *

First

Last

Nominee's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Layout

Nominee's Home Phone

Nominee's Cell Phone

Nominee's Email Address *

Nominator's Information

Please provide your contact information.

Nominator's Name *

First

Last

Organization/Business Name

Nominator's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Nomintor's Phone Layout

Nominator's Home Phone

Nominator's Business Phone

Nomintor's Cell Phone

Nominator's Email Address

Date of Nomination *

What's Your Relationship to The Nominee? *

Familiarization *

Years of Volunteerism

References

Please provide two references who are familiar with and can verify the scope and extent of the nominee's volunteer service activities. These people may not be the nominator, nominee, or a relative of the nominee. Please make the individuals aware they may be contacted.

Reference #1

Reference #1's Name *

First

Last

Reference #1's Phone Numbers

Reference #1's Home Phone

Reference #1's Cell Phone

Reference #1's Email Address

Reference #2

Reference #2's Name *

First

Last

Reference #2's Phone Numbers

Reference #2's Home Phone

Reference #2's Cell Phone

Reference #2's Email Address

Nomination Questions

Nominations will be evaluated based on your answers to the questions below. Please be specific and detailed. All responses should be 500 characters of less.

Question #1 *

Question #2 *

Question #3 *

Question #4 *

Question #5 *

EMERGENCY DIAL 911

FIRE ADMINISTRATION

About Us

Leadership

District Board of Directors

Departments

Firefighting (Fire Suppression)

Paramedics

Urban Search & Rescue

Hazardous Materials

Permit Portal

Inspections

Fire Administration

Fire Station 61

Fire Station 62

Fire Station 63

Fire Station 64

Fire Station 65

Fire Station 66

Fire Station 67

Fire Station 68

Community Education

Community Involvement

Programs For Youth

Public Requests

Chino Valley Fire District

FAITHFULNESS. INTEGRITY. RESPECT. EXCELLENCE.

Nominee's Information

Nominator's Information

References

Reference #1

Reference #2

Nomination Questions

QUICK LINKS

LEGAL

PARTNERSHIPS