Distinguished Service Award Application

Criteria--Nominees should have: Made an outstanding contribution to community progress Supported many and varied civic and charitable causes in an active role Assumed the duties & responsibilities each citizen owes its community, including church activities Provided inspiration to others as a model citizen Excelled in a volunteer field, which is for the benefit of mankind with particular recognition for pioneering work in such field Note: Public or political popularity shall not be considered a valid reason for nomination or selection.
Nominee First, Middle, Last Name:

Address:

Spouse’s name:

Education:

Employer / Years employed (if known):

Military service (list branch of service, rank and any medals, awards, etc.):

I. List awards and recognition nominee has received for volunteer work in the community.

II. List civic & charitable affiliations. (i.e. scouts, church, school and civic organizations)

III. In what ways does this individual provide inspiration as a model citizen? (List examples)

IV. Why does this person, above others, deserve this award? (attitude, dedication, perseverance, etc.)

Other Comments:

Note: If the "Send Application" button does not appear to do anything, review the entire form ensuring no errors have been indicated in red!