Good Citizenship Award Nomination Form

    Nominee

    First Name (required):

    Last Name (required):

    Organization (if applicable):

    Title (if applicable):

    Address:

    City:

    Zip Code:

    Phone Number:

    E-mail:

    Individual Submitting the Information

    First Name (required):

    Last Name (required):

    Address:

    City:

    Zip Code:

    Phone Number:

    E-mail:

    Please describe why you think this person should be considered for the Orange City Good Citizenship Award. Eligible recipients (individuals, couples or groups/organizations) should meet at least one of the following criteria:

    • Demonstrated exceptional volunteer service that shows a dedication to making Orange City a great place to live, work, play or learn.

    • Made a positive difference in a fellow citizen's life or has demonstrated a care and concern for Orange City and its residents.

    • Worked with or organized other individuals to solve a problem in Orange City or has a mission to better Orange City in a positive way.

    • Displayed the qualities of honesty, integrity & service and is an example to Orange City residents.

    When answering the criteria-related questions, please use specific examples and details of why this person(s) deserves this award. Your responses are how the Council will select the recipient of the award.

    How has the nominee demonstrated exceptional volunteer service that shows a dedication to making Orange City a great place to live, work, play or learn? Please be specific.

    How has the nominee made a positive difference in a fellow citizen's life or has demonstrated a care and concern for Orange City and its residents? Please be specific.

    How has the nominee worked with or organized other individuals to solve a problem in Orange City or has a mission to better Orange City in a positive way? Please be specific.

    How has the nominee displayed the qualities of honesty, integrity & service and is an example to Orange City residents? Please be specific.

    Is there anything else you would like to share about the nominee?

    Attach a photo/document to the submission

    Attach a photo/document to the submission

    Attach a photo/document to the submission



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