2010

JOINT SERVICE CLUBS COMMUNITY SERVICE RECOGNITION AWARD

NOMINATION FORM

1. The candidate has made an extra-special effort to make Barre a better place to live.

2. The candidate lives or has lived a minimum of three years in the general area that is affected by Barre and its functions.

3. The candidate can be of any age; can be posthumously considered; can be a couple or group working together on the same project.

4. The candidate’s accomplishments are not generally known by the community.

5. The candidate’s name will be presented to the Joint Service Clubs Committee.

Name: _________________________________________________________________

Address: _______________________________________________________________

Phone: ________________________ E-Mail: ________________________________

If deceased or out of the area:

Contact Person: __________________________________________________________

Address: ________________________________________________________________

Phone: __________________________ E-Mail: _______________________________

Number of years in Barre area: _____________________________

Brief personal, family & professional history:

Detailed explanation of the services performed: what was done, where and when it was done, for how long, and who benefited, how the program got started, numbers involved, reasons that motivated the individual or group. Was the service connected with the nominee’s professional or business practices, and if so, what qualified this as volunteerism and not part of his/her daily job?

Page 2.

APPLICATION FOR NOMINEE OF THE JOINT SERVICE CLUBS

COMMUNITY SERVICES RECOGNITION AWARD

How does the nominee’s community service follow the criteria of making Barre a better place to live?

Has the nominee been honored by the community prior to this recognition? If so, explain. A special effort should be made to present nominees whose accomplishments are not generally known by the community.

NOTE: Attach additional information as necessary.

__________________________________ ______________________________

Sponsor’s Name Sponsor’s Name

__________________________________ ______________________________

Sponsor’s Phone # Sponsor’s Phone #

__________________________________ ______________________________

Sponsor’s E-mail Sponsor’s E-mail

RETURN BY: September 1, 2010

Return to Aldrich Public Library, 6 Washington Street, Barre, VT 05641

or to a member of a Joint Service Club (Altrusa, Kiwanis, Lions or Rotary)

NOTE: This is an application only. All applications will be reviewed by the

Joint Service Clubs Committee and considered for the Recognition Award.

Thank you for your time and commitment to our program.