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2. Parks and Streets Naming Nomination Form

   This Form is to allow residents to submit names for nomination to be included in the list of approved names for naming parks and streets by the Town of Poolesville. The town's naming policy provides several criteria for the nominated names, which you can find below. Nominations are reviewed by the Parks board and approved by the town Commissioners. Nominators maybe asked to attend a parks board meeting. 

   A street, park, and field name will be considered only if it falls into one of the following
   categories:
   1. An individual who has at least ten (10) years of service with the Town in an elected and/or appointed capacity and is not currently in office or serving on a board or
   commission;
   2. An individual who has made a significant contribution to the Town or Community;
   3. A name with local historical significance;
   4. A name of flora or fauna indigenous to the area.
   
   

4. Date
   Date
6. First Name
7. Last Name
9. Address1*
11. City
12. State
13. Zip
15. Email Address*
17. Nominee First Name*
18. Nominee Last Name*
20. Historical or Community significance of the individual being nominated*
22. Supporting Documentation *
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field