Governor-First Ladys Service Awards

By Louis Rodriguez,2014-11-24 08:42
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Governor-First Ladys Service Awards

Governor-First Lady’s Service Awards

    Nomination Form

I. Nominee Information

    Nominee's Name: __________________________________________________________________________________

    Mailing Address: ____________________________________________________________________________________

    City: ___________________________________________ Zip Code: _________________________________________

    E-mail Address: _____________________________________________________________________________________

    Phone - Day: ( ) ____________________________ Evening: ( ) ________________________________

II. Nominator Information

    Note: Nominators will be contacted after judging is complete.

    Your Name: ______________________________________________________________________________________________

    Mailing Address: _________________________________________________________________________________________

    City: _______________________________________________ Zip Code: ___________________________________________

    E-mail Address: ___________________________________________________________________________________________

Phone Day: ( ) ____________________________ Evening: ( ) ___________________________________

III. Award Category

    Please complete all sections. See separate sheet for General Information and Award Category Descriptions. Choose only one award category, per nomination form:

    Outstanding Adult Volunteer (individual, 18 years and older)

    Outstanding Youth Volunteer (individual, under age of 18)

    Outstanding Corporate Volunteer Program

    Honoring Ohio’s Small Business (less than 500 employees)

    Honoring Ohio’s Large Business (more than 500 employees)

    Outstanding National & Community Service Participant or Program

    Outstanding Volunteer Group

    Outstanding National Days of Service Project (Martin Luther King Jr. Day of Service,

    Global Youth Service Day, 9/11 Day of Service and Remembrance, Make A Difference Day)

IV. Required Attachments

    Use no more than 4 - 8.5 x 11-inch sheets (one side). The nominee’s accomplishment must be double-spaced, with 10 point or larger type-size. Type or write legibly and provide all requested information.

Nominations will be judged on the following criteria:

    A. Nominee’s Accomplishments (50 points) - In narrative form, explain why the nominee deserves

    this award (include activities directly related to award category criteria). Describe

    accomplishments and characteristics that may distinguish the nominee from others. B. Data (35 points) - Provide quantitative evidence within the narrative of nominee’s involvement

    and impact, i.e. measurable impact on community, number of people served, length of service,


    C. Supporting Documentation (15 points) Attach supporting documents …photos, newspaper

    clippings and/or letters of support (use no more than 2 of the maximum 4 pages allowed for

    this section). Materials become the property of the Ohio Community Service Council and may

    be used for promotional purposes. Materials will not be returned.

V. Legislator Information

    Please provide the following information so that OCSC may contact an area legislator of a winning nomination:

    District Number Name

    U.S. Representative: ___________________ _________________________________________ State Senator: ___________________ _________________________________________ State Representative: ___________________ _______________________________________

VI. Reference:

    Nominees must have at least one reference, in addition to the nominator. Relatives of nominees

    may not be used as a reference. Please alert the individual they may be contacted and why.

Name: ________________________________________ Phone Number: (______) _____________________________

VII. Submission Checklist

    Please initial each item before mailing your nomination!

    ______ I am sending 4 copies, including the original, of the completed nomination form, narrative, and supporting documentation to:

    Ohio Community Service Council

    ATTN: Governor-First Lady’s Service Award

    51 N. High Street Suite 800

    Columbus, Ohio 43215

    ______ Volunteer service was completed in Ohio during the 2010 calendar year.

     No exceptions will be made.

    ______ I understand my nomination may be disqualified if instructions are not followed. ______ No fax or hand delivered copies accepted.

    ______ Nomination packets must be postmarked or received by December 31, 2010


Thank you!

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