Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

2018 Monument To Freedom, Justice & Courage Nomination

  1. 2018 Monument To Freedom, Justice & Courage Nomination

  2. Jackson County Seal

  3. NOTE: To submit this form you do not have to sign in or create a Jackson County Form Center account above. However, you will have to complete the form in its entirety without the option to save your progress unless you do create an account.

    The Jackson County Freedom Wall Commission seeks to recognize outstanding individuals who have demonstrated, either currently or in the past, exceptional leadership qualities in their ongoing efforts to enhance the African American community in a variety of sustainable ways.

    All materials must be submitted by 4:30 p.m. CST, Thursday, May 3, 2018. No exceptions.

    All nominations must be complete when submitted, including bio and, if available, photo.

  4. Questions

    e-mail or call (816) 881-3163

  5. Nominee Information

  6. Posthumous*

  7. Please provide a bio of the person you are nominating. (.doc and .pdf files only)

  8. Please provide a photo, if available, of the person you are nominating.
    (.jpeg, .png, .tiff, .pdf files accept)

  9. Submitted/Nominated By

  10. Nomination On File*

    If your nominee is not selected, would you like us to keep their form on file for future consideration?

  11. Acknowledgement*

    By clicking "I agree," you agree and acknowledge that information provided in this form is, to the best of your knowledge, true and accurate.

  12. e-Signature

    By typing your name in the "Signature" box below, you acknowledge that this "electronic signature" is valid and binding upon you to the same force and effect of a traditional handwritten signature.

  13. Leave This Blank: