Name

First Name

Last Name

Phone

(###)

###

####

What three words would you use to describe yourself?

What accomplishments in your life are you most proud of

What is the most important lesson you learned from the nonprofit program that you completed?

What are some challenges you have faced in recent years?

What does staying power mean to you?

Who or what motivates/inspires you to continue exhibiting staying power?

What advice quotes or words do you live by?

Where do you see yourself in 5 years?

Is there anyone you would like to dedicate this award to?

How do you want your full name spelled on your engraved award?

Please pick a date available for a video shoot and we will reach out and schedule:

Recording will take place at the M:STL building and times are from 5:30 - 8 p.m.

10/17

10/22

10/24

10/29

10/31

11/4