Aached is the oﬃcial nomination form for KSBW-TV Jeﬀerson Awards and a sample nominationfor your reference. All information must be complete to qualify. DO NOT USE PENCIL.A panel of judges will review each qualifying nominee. Six nominees will be honored locally byKSBW-TV and will receive the Franklin Mint Gold Medallion. One of the honorees will beselected by a panel of judges at the national oﬃce to be honored in Washington, D.C. in June 2012.Your nomination is limited to the following 3 pages:
is the cover sheet which contains the recipient contact informationand the nominator contact information.
is the one page nominee bio which answers the 6 questions posedin the biography instructions.
should include the nominee’s name and two references, other than yourselfwho can verify the nomination information. Be sure to include the reference name,address, phone number and email address.Please do not submit any aachments such as pictures, videos or any other addendum.Completed forms should be mailed or emailed back to KSBW-TV. The address is KSBW-TV,238 John Street, Salinas, CA 93901. You can fax or email it to the aention of Theresa Wright at(831) 424-3750 or
All entries must be received no later than 4:00PM on Friday, February 1, 2013.Incomplete entries and entries received after that date and time will not be accepted.
Annual KSBW Jefferson Awards”