Governor and First Lady’s Medals for Service
MAIL-IN NOMINATION FORM
Nominations for the inaugural Governor and First Lady’s Medals for Service must be
received by CaliforniaVolunteers by 5:00pm on May 22, 2009. Online nominations are
strongly encouraged and should be submitted via the CaliforniaVolunteers.org website. Mailin nominations are acceptable and can be mailed to:
CaliforniaVolunteers
Governor and First Lady’s Medals for Service Nominations
1110 K Street
Sacramento, CA 95814
Please fill in the fields in grey. All fields are required unless otherwise noted.
SELECT ONE CATEGORY FOR YOUR NOMINATION
California’s Volunteer of the Year
An outstanding Californian whose volunteer service is exemplary and inspirational
California’s Business Volunteer Program of the Year
A California business with an innovative, high-impact employee volunteer program
California’s Nonprofit Leader of the Year
A California nonprofit leader who has shown an extraordinary ability to leverage
volunteers in service to their organization
TELL US ABOUT YOU
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Email Address:
Phone: (
)
-
What is your relationship to the person you are nominating?
Self
Family member
Friend
Co-worker
Business I work for
Other:
TELL US ABOUT THE NOMINEE
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Email Address:
Phone: (
)
-
Company / Organization (not required for Individual nominees):
Website (not required for Individual nominees):
1. Please describe in detail this nominee’s specific volunteer activity(s) and what was
involved in achieving it (them). (500 words maximum)
2. Describe how the nominee’s volunteer work addressed a critical community need
and/or strengthened California communities, including significant improvements with
measurable outcomes for an organization or community. (200 words maximum)
3. Describe how the nominee collaborated with others, leveraged community resources
and/or employed a unique approach to solving problems. (200 word maximum)
4. Is there a specific incident or turning point that inspired this nominee to become
engaged in volunteering? (200 words maximum)
5. Describe how the nominee’s service reflected a dedicated and sustained
commitment of time and effort. (200 words maximum)
PLEASE ALSO ATTACH:
1. Letter of Support from someone other than the Nominator. (REQUIRED)
2. Additional Materials (OPTIONAL). This can include additional information or letters
of support, photos, testimonials, news clippings, pamphlets, etc. PDF attachments
are preferred; Word document attachments are acceptable. Electronic materials
(video, CD, etc.) are acceptable and should be included as part of a mail-in
nomination. Electronic materials should be no longer than 5 minutes in length.