DSA Nomination Form
RequiredRequired Question(s)
 
Distinguished Service Awards (DSA) Nomination Form

We are seeking nominations for the 2018 Distinguished Service Awards.

A Chamber Selection Committee will choose candidates who have made contributions to our diverse community by:

Performing outstanding volunteer community service over several years
Participating in more than one community project or committee 
Giving time outside of business, profession or vocation 
Providing recognized leadership in community affairs

Please provide nominee name and contact info for each award.
 
Complete the form and submit by Monday, 12 February, 12pm.

Thanks! 
 
2018 DSA Committee
 
Required 1.
Senior First Citizen  (persons 50 years or better)

Name of Nominee:________________________________

Phone:________________ 

Please describe how the nominee is distinguished in the following areas:  

1  Voluntary community service over several years
 
2  Activities and leadership in community organizations
 
3  Areas of inspiration or outstanding performance  
 
4  What made this person stand out to you?  
 

1000 characters left.
Required 2.
Junior First Citizen  (Under 50 Years) 

Name of Nominee:________________________________

Phone:________________ 

Please describe how the nominee is distinguished in the following areas:
  
1  Voluntary community service over several years 
 
2  Activities and leadership in community organizations 
 
3  Areas of inspiration or outstanding performance 
 
4  What made this person stand out to you? 
 

1000 characters left.
Required 3.
Outstanding Youth  (College & High School)

Name of Nominee:________________________________

Phone:________________

Please describe how the nominee is distinguished in the following areas:  
 
1  Voluntary community service over several years
  
2  Activities and leadership in community organizations 
 
3  Areas of inspiration or outstanding performance  
 
4  What made this person stand out to you?
 

1000 characters left.
Required 4.
Outstanding Educator  (Teachers, Support Staff, Administrators) 

Name of Nominee: _____________________________

Phone: _______________

Please describe how the nominee is distinguished in the following areas:
 
1  Values and celebrates diversity
  
2  Builds positive, trusting, respectful relationships with students, families, staff & community
  
3  Promotes and models lifelong learning as the key to the student's future success
  
4  Promotes involvement and partnership between school and home
 

1000 characters left.
5.
For additional space, indicate nominee(s) & award(s) referred to: 
 

1000 characters left.