SOM - State of Michigan



2020 Governor’s Service Awards sample organization nomination formInput your answers at Contact InformationNominator Name (include your title if applicable)Organization (if applicable)Address:Address 2:CityState: ZIP:Email Address:Daytime Phone Number What is your relationship to the Nominee?Family MemberFriendNeighborFellow VolunteerCo-WorkerSupervisorEmployerBoard MemberMember of Organization/BusinessOther (please specify)Enter information of INDIVIDUAL or GROUP you are nominatingNominee Name (include Suffix)Organization (if applicable)AddressAddress 2CityStateZIPEmail AddressDaytime Phone NumberAre you nominating an Individual or Organization/Business?IndividualOrganization or BusinessList the community(ies) and county(ies) in which the Nominee serves/volunteers:6. For which Award are you making a nomination?Outstanding Volunteer Organization AwardEducation Service Leader AwardOutstanding National Service Program AwardCorporate Community Leader Award (100+ employees)Small Business Community Leader Award (<100 employees)7. What programs or projects has the organization implemented or participated in?List important programs or projects, the total number of volunteers and hours served a brief description of what was accomplished.Examples:Comcast Cares Day (2019)Comcast Cares Day is a celebration of our company’s year-round commitment to service, and has grown to become the nation’s largest single-day corporate volunteer event. On Saturday, April 30, more than 2,500 Michigan Comcast employees, their families and friends volunteered to assist nonprofit organizations around the state of Michigan.2,500 volunteers10,000 service hoursTroy Athens High School Charity Week (2007-2019)Fundraising campaign - raised $500,000The largest act of service by Troy Athens High School is their annual Charity Week produced entirely by the students each February. In the last 10 years, it has raised $500,000 for charities through various student led activities8. Tell the story of impact that the organization or business has made?How has the Nominee produced lasting change and/or demonstrated community impact?How has the organization or business successfully supported its employees/volunteers/members and engaged them in community volunteer opportunities?9. What relationship does the Nominee have with the community?Has the community honored the Nominee?Provide any quotes from individuals describing the nominee's service (Please do not plagiarize from news publications)10. Please provide two references familiar with the Nominee’s volunteer activities. References MAY NOT be the Nominator, Nominee, or someone RELATED to the Nominee. Please inform the references they will be contacted.Reference #1 - Name & Title if applicableRelationship to NomineeMain Phone Number Email AddressReference #2 - Name & Title if applicableRelationship to NomineeMain Phone Number Email Address11. Certification on Organization/Business Letterhead (if applicable)If the Application was not completed by a staff member at the Organization or Business being nominated, you must provide the organization with a copy of the application submitted for their review. Ask them to provide you with any additional information that will more accurately reflect their service and commitment to the community and/or state. The Nominee must submit on their letterhead the following statement for you to attach to the application: I certify that I have read the application and that it accurately reflects and contains all of the information about the volunteerism/service of our organization/business.12. Upload supporting documents13. Upload signed background check form14. Upload photosPlease upload action photos of nominee in service and a high-quality headshot2019 Governor’s Service Awards guidelinesPART I. AWARD CATEGORIESA. Individual Awards 1. Governor George Romney Lifetime Achievement AwardAn individual who demonstrates a lifelong commitment to community involvement and volunteer service.This individual has taken their volunteer service to the highest level and has shown a tremendous passion for helping others.He/she is highly regarded for making a tremendous impact in their community or the state.2. Lifetime Humanitarian AwardAn individual or family that has demonstrated a lifetime of outstanding civic and charitable responsibility to a community or organization.This individual or family is a role-model and exhibits selfless commitment to the community and tireless actions which may include significant monetary contributions, serving on community board(s), and/or leading major community projects.3. Senior Volunteer of the Year AwardIndividuals 65 or older who are taking action to make their community a better place.These individuals share their many years of experience and are role models for others to serve and volunteer.4. Volunteer of the Year AwardIndividuals over the age of 25 who strive to improve the lives of people in their community or state.These individuals make impact through volunteering in various capacities with nonprofits and organizations, showing a commitment to strengthening communities.5. Youth Volunteer of the Year AwardIndividuals age 25 and younger who work hard to make an impact in their community through volunteerism.These individuals create solutions to make lives better and demonstrate the spirit of being change makers. 6. Mentor of the Year - Youth Support AwardIndividuals who mentor youth or support youth development. These individuals tirelessly offer guidance, support, and encouragement to cultivate the positive and healthy development of an individual or group of youth.B. Organization and Business Awards1. Outstanding Volunteer Organization AwardService Club, Nonprofit, Faith-based, Veteran, Disaster Preparedness, or other organization that makes a demonstrated difference in their community or the state by inspiring people to volunteer.2. Education Service Leader AwardSchools, Colleges/Universities, or other organizations that support youth to engage in service and volunteerismThese organizations assist youth in making a difference both on campus and in their communities.3. Outstanding National Service Program AwardAmeriCorps State, AmeriCorps VISTA, AmeriCorps National, Senior Companions, Foster Grandparents and RSVP programs that successfully make an impact in communities and successfully support their service members.4. Corporate Community Leader (100+ employees) Award and Small Business Community Leader (<100 employees) AwardCorporations/Businesses that are committed to all levels of volunteerism and service in their communities and/or the state.This commitment could include supporting employees to volunteer, developing formal volunteer programs, or providing monetary contributions and in-kind gifts.PART II. NOMINATION INSTRUCTIONSA. Decide Who to NominateThe goal of the Governor’s Service Awards is to recognize outstanding and extraordinary volunteer service efforts by individuals and organizations. Nominees are selfless individuals and organizations who volunteer and serve to make an impact in communities in the State of Michigan.Awards are for recognition for service that is not part of a paid position. All completed nomination applications will remain active for three years.B. Select the Award CategoryReview the Award categories and select the one that best matches your nominee.Once the appropriate category has been chosen, familiarize yourself with the information that needs to be provided in the application and answer all the narrative questions as completely as possible. C. Complete the Application Applications are due by Jan. 15, 2019.Provide as much relevant information as possible about your Nominee. Your application tells the story of why your nominee deserves to be honored as one of the outstanding volunteers in Michigan.D. Submit Supporting DocumentsWe strongly encourage you to submit supporting documents. These materials help strengthen your nomination and often offer the extra element your nomination narrative needs. Examples include: letters of support from the community and those who were served, news articles, and any other items that demonstrate the Nominee’s commitment to service.There will be an opportunity to upload your supporting documents at the end of the online application. Please keep in mind supporting materials will not be returned to you.PART III. SELECTION PROCESSAll nominations go through an extensive review process that involves a volunteer Peer Review Panel.The Michigan Community Service Commission Board of Commissioners and the Office of the Governor make the final selections.There may be multiple award winners in each category.Awardees and their nominators will be notified a month before the awards ceremony.The honoree or an agreed upon representative must be present to receive the award. If you have any questions or need additional information, please visit GovernorsServiceAwards, call the Michigan Community Service Commission at 517-335-4295 or email GSA@ ................
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