Distinguished Voluntary Service

2. Name, team or group of nominee*

4. Full address of nominee*

6. Phone # of nominee*

7. Email of nominee

9. Nomination is for:
   -- Select One --A specific eventContinuous service

10. Date and location of achievement (if applicable)

12. Describe why this nominee deserves this award:*

14. Additional documents
    Additional documents may be attached to complete your submission. The Selection Committee reserves the right to assign a nomination to an alternate category, provided the nominator agrees to the reassignment.

    Additional documents may be attached to complete your submission. The Selection Committee reserves the right to assign a nomination to an alternate category, provided the nominator agrees to the reassignment.

16. Upload additional documents

18. Name of nominator *

20. Full address of nominator *

22. Phone # of nominator *

23. Email of nominator

25. Signature of nominator *

    Type your name in lieu of signature.

27. Name of seconder*

29. Full address of seconder *

31. Phone # of seconder*

32. Email of seconder

34. Signature of seconder*

    Type your name in lieu of signature.

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field