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2020 Governor’s Service Awards sample individual 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:What is the age of the Nominee?Select the award for which the INDIVIDUAL is being nominated?George Romney Lifetime Achievement AwardSenior Volunteer of the Year AwardVolunteer of the Year AwardYouth Volunteer of the Year AwardMentor of the Year AwardLifetime Humanitarian Award (this may be individual or family)8. Volunteer Service: List the organizations the nominee has served with, the years served, the total number of hours served with that organization and a brief description of what was accomplished. (This could include volunteering with nonprofits, serving on boards, supporting or leading projects or programs, or raising money for projects.)Examples:Habitat for Humanity (2011-2019)Volunteer hours: 1,000Served as project leader and helped recruit 350 volunteers and build 15 homesSaint Mary's Foundation (2005-2011)Led fundraising campaign and raised $50 million for children's hospital9. In your own words, tell the story of the Nominee's impactHow has the Nominee produced lasting change for an individual, organization, or community?How has the Nominee been an inspiration for others to volunteer/serve?What is unique about the Nominee's service that is deserving of recognition?10. What level of community engagement has the nominee been involved in?What is the reputation of the nominee in the community?Provide any quotes from individuals describing the nominee's service (Please do not plagiarize from news publications)11. List any service/volunteerism awards the nominee has won.12. 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 Address13. Upload supporting document14. Upload signed background check form15. 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.You are strongly encouraged to first prepare your responses to questions in a sample document and then simply cut and paste text into the online application. 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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