Excellence Awards Form

Name(s) *

First

Last

If filling out for a couple, please list both names.

Date(s) of Birth

If filling out for a couple, please provide both dates

Email(s) *

If filling out for a couple, please list both emails

Name(s) of Spouse/Children

Church membership

Past and current leadership roles in the church

List ministries or community organizations and the ways you've been involved

Share the ways you've been involved in CBF or CBF Heartland

We’d like to contact a few people who can share about you and your ministry impact.

Reference 1 *

First

Last

Reference 1 email *

Reference 2

First

Last

Reference 2 email

Reference 3

First

Last

Reference 3 email