Nomination Form

Each year, Aging Together honors five remarkable older adults from our region during the 5 Over 65 Celebration. One individual from each of our five counties—Culpeper, Fauquier, Madison, Orange, and Rappahannock—is chosen based on public nominations. The selection criteria are outlined below. The honorees will be revealed in May 2026 and celebrated at our event on August 27, 2026, at Fauquier Springs Country Club (stay tuned for more details!).

Criteria for nominations:

- The individual must be 65 years of age or older.

- The individual must reside or work in one of the five counties in our region: Culpeper, Fauquier, Madison, Orange, or Rappahannock.

- The individual must have made significant contributions to the community through volunteerism or similar impactful service.

Consideration
The Aging Together Award Committee will take the following into consideration in selecting the successful candidates:

Has the nominee inspired by being involved with mentoring others? If so, how and how many? Who is being mentored?
Has the nominee been involved with supporting others working in their cause(s) – Is the person working “behind the scenes” and worthy of recognition? Are they going above and beyond the expectation for the role? What is their level of commitment?
Is there an unmet need or an underserved group that is being helped?
If involved with non-profit organizations, what is their level of involvement (founding member, heavily involved, some service)?
Remember that, though you may know your nominee well, the decision committee does not and it is up to you to give them enough information to encourage their choosing that person. If only a short paragraph is submitted with few details about who they are they will not be chosen. The more details you can give, the better the chance your person will be picked!
A person who has been nominated before can be nominated again, but a new submission is required. Nomination forms from previous years are no no longer available or valid.

Contact Us

Name of person (or persons) SUBMITTING this nomination:

Phone Number (*required):

Email Address (*required):

Mailing Address of person submitting this nomination (required):

Preferred contact method?

Phone

Name of person BEING NOMINATED:

Phone Number of nominee (*required):

Email Address of nominee (*required):

Mailing Address of nominee (required):

Which County are you submitting this nomination for (please check one)?

WHY ARE YOU NOMINATING THIS PERSON? Be specific about ways this person has given to the community and describe any contributions they have made (outside of their job if employed). For example, do they volunteer significant time and resources? Are there ways they have been a catalyst for positive change? Are they a good mentor? Have they become involved in challenges that positively affect the region? Please use a minimum of 300 words and be as detailed as possible. Use additional pages if necessary.

Please let us know of any organizational affiliations or volunteer work in which the nominee participates, or has in the past? (What level of involvement do they have)

Do you have any good stories about this person, or is there something about them no one else may know? Why should the nominating committee choose this person they may not know

Contact Us

Name of person (or persons) SUBMITTING this nomination:

Phone Number (*required):

Email Address (*required):

Mailing Address of person submitting this nomination (required):

Preferred contact method?

Phone

Name of person BEING NOMINATED:

Phone Number of nominee (*required):

Email Address of nominee (*required):

Mailing Address of nominee (required):

Which County are you submitting this nomination for (please check one)?

Please let us know of any organizational affiliations or volunteer work in which the nominee participates, or has in the past? (What level of involvement do they have)

Do you have any good stories about this person, or is there something about them no one else may know? Why should the nominating committee choose this person they may not know

CONTACT INFO

PHONE

ADDRESS

EMAIL

5 Over 65 Nomination Form

Contact Us

Contact Us

CONTACT INFO

PHONE

ADDRESS

EMAIL

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