Council Award Endorsement Form

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Award: *

Nominee Information

Name of Nominee: *

Address: *

City: *

State: *

Zip Code: *

Phone: *

Email address: *

Endorsement

Please elaborate on your reasons for endorsing this nomination. Make sure to include how the candidate met the award criteria, their specific accomplishments, and any other comments that might be helpful. *

Endorser Information

Name of endorser completing this form: * 🛈

Your e-mail: *

How you know the nominee: *

Please list the names and contact information for the other individuals signing this letter of endorsement. Check the award criteria for the number of required signatures for this award.

Name #1:

E-mail:

Name #2:

E-mail:

Name #3:

E-mail:

Name #4:

E-mail:

Name #5:

E-mail:

Electronic Signature By typing my name on this form, I am entering my "electronic signature" (as defined in The California Uniform Electronic Transactions Act 1633.1 - 1633.17) and certifying that I have read, fully understand and accept all terms of this agreement. *

Published February 24th, 2017. Updated 2/6/19

* Please Note: Once you submit this form, you'll have the option to print the form contents on the following page.