Nomination for Muslim Youth Activism Award:
(Please copy, fill out and send back to CAIR-LA)

Your Information
Name: 
Email Address: 
Phone Number: 

Nominee Information
Name: 
Email Address: 
School: 
Age:
Phone Number:

Nominee Accomplishments/Achievements/Volunteer Efforts:
(Please submit a few lines on why you think your nominee deserves this award.)