Community Service Award Nomination

Community Service Award Nomination
The adult recognition program at GSSJC offers National and Council award pins, plaques and certificates for outstanding service and accomplishments that go above and beyond the expectations for that role. Submit complete nominations using the online submission form to the Council Adult Recognition Committee by March 1. Recognition nominations which are incomplete will not be considered. Late nominations will be returned to first signer to nominate the following year.
Nominee Information
Nominee*

First NameLast Name
Nominee Address*

Street Address

Street Address Line 2

CityState

Zip Code
Nominee Phone (Daytime)*
Please enter a valid phone number.
Nominee Phone (Evening)
Please enter a valid phone number.
Nominator Information

The first nominator named below will be contacted if additional information is needed, notified of the recognition awarded and have the option of reading the speech if presented at an Adult Recognition Event. Letters of endorsement from a total of three registered Girl Scout nominators are required.

Download F-54A Letter of Endorsement
Please list the person who will be considered “First Signer” and receive communications about this nomination.
Nominator #1*

First NameLast Name
Nominator #1 Phone*
Please enter a valid phone number.
Nominator #1 Email*
example@example.com
Upload Nominator #1 Letter of Endorsement *

Cancelof
Nominator #2*

First NameLast Name
Nominator #2 Phone*
Please enter a valid phone number.
Nominator #2 Email*
example@example.com
Upload Nominator #2 Letter of Endorsement *

Cancelof
Nominator #3*

First NameLast Name
Nominator #3 Phone*
Please enter a valid phone number.
Nominator #3 Email*
example@example.com
Upload Nominator #3 Letter of Endorsement *

Cancelof
Nomination
Current service or support provided by nominee*
Please list any awards (including dates) earned by the nominee*
How did the nominee deliver service beyond expectations? *
How long has the individual or organization provided support and to whom?*
List the impact and results of this nominee's contribution toward the Girl Scout Movement:
Specific audience benefiting from support
Award Presentation
All nominations must be submitted no later than March 1, 2025. Please select the method of presentation if an award is granted.*

Adult Recognition Event, April 12,2025Council Meeting (Fall)Community Event (Spring/Summer)Community Event (Fall)
If you selected 12 weeks, please list your location:
Should be Empty:

Community Service Award Nomination

Nominee Information

Nomination