Assisting with Positive Community Impact


(678) 938-5799


P.O. Box 1957
Conyers, GA 30012

Community Impact Award Form

Thank you for considering the nomination of someone deemed to be an individual who has made a positive community impact. The selection process and timeframe are fluid and continuous. We do want a “deadline” to be a reason for not recognizing the wonderful work being done in our communities, so take your time and complete the nomination as prescribed below.
The application process has two (2) parts. Essential Information and a Nomination Letter.
The Essential Information will be entered in the following section. Upon completion of data entry, the nominator will need to upload a Nomination Letter. Guidelines for the Nomination Letter has been provided below

Step 1: Essential Information

On a separate document, please provide the following information.

Nomination Letter

Nomination letter is a separate document and should not exceed two single-spaced, single-sided, letter-size (8.5" x 11") pages and should be typed using a standard 12-point font.

Use the following guidelines to help compose your nomination letter:

  • Use the letter to provide a complete picture of the nominee's accomplishments. Assume that the selection committee is completely unfamiliar with the nominee's work.
  • Include specific examples that address what the nominee has achieved, how the nominee accomplished these achievements, and why the nominee's achievements have significance that should be recognized with a James A. “Bud” Cody Community Impact Award:

a. Explain what efforts the nominee has contributed to a community/program that are unique, exceptional, or go beyond his or her job duties. Describe efforts such as—

    • extraordinary actions,
    • significant obstacles overcome, and
    • groundbreaking achievements.

b. Explain how the nominee has demonstrated leadership or teamwork in achieving these efforts. Describe elements such as—

    • visionary thinking or initiative,
    • innovative methods or creative ideas, and
    • collaboration or bringing together different groups.

c. Explain why the nominee's efforts represent change for communities or community services that is or will be enduring. Describe efforts such as—

    • extraordinary benefits or funds raised,
    • policies, ordinances, or laws that have been developed/passed, and
    • programs that have been replicated or influenced.
  • Be as specific as possible, and include milestones, numbers, statistics, and monetary amounts where appropriate.
  • Write clearly and directly and include pertinent details without providing extraneous or unrelated information.
  • Ensure that all information submitted is accurate.

Upon the completion of the document, upload it with the following link:

In the event the selection committee needs additional or clarifying information, the committee contacts the nominator. Furthermore, if the nomination proceeds to the selection as a finalist, the nominee will be notified as well as the nominator.

If you have any questions, please do not hesitate to contact Derek Marchman at [email protected] or 678-938-5799.