Honorary Service Award Nomination Form For Unit, Council And District Ptas printable pdf download

2327 L Street, Sacramento, CA 95816-5014

916.440.1985 • FAX 916.440.1986 • •

HONORARY SERVICE AWARD*

NOMINATION FORM FOR UNIT, COUNCIL AND DISTRICT PTAs

The Honorary Service Award Selection Committee requests that members of _______________________________

PTA/PTSA assist in the selection of deserving recipients for recognition at PTA/PTSA event or at a PTA meeting.

Nominated individuals or organization who have made significant contributions to the well being of children, youth or

families in this school and/or community can be considered for this award. Current members, officers and teachers

may also be considered for this award.

*Honorary Service Award Program includes the Honorary Service Award (HSA), Continuing Service Award (CSA), Golden Oak

Service Award (California’s highest honor), Very Special Person Award (VSP) and Donations in name of individual or organization.

(See Toolkit, Section 7.6.3 Honorary Service Award (HSA) Program)

HONORARY SERVICE AWARD PROGRAM

– – – p l e a s e p r i n t – – –

Specify award category:

q Honorary Service Award (HSA)

q Very Special Person Award (VSP)

q Continuing Service Award (CSA)

q Donations

q Golden Oak Service Award

Name of individual nominated: __________________________________________________________________

Title or position: ________________________________________________________________________________________

Name of organization nominated: ________________________________________________________________

Contact Person: ________________________________________________________________________________________

Address: ______________________________________________________________________________________________

Telephone: (_____)___________________ Email: ______________________________________ _______________________

Reason for nomination:

______________________________________________________________________________________________________

Name of person submitting the nomination: ______________________________________________________

Telephone: (_____)___________________ Email: _____________________________________________ Date:___________

All nominations will be considered. The HSA Selection Committee will select the recipient.

Nomination DUE DATE for presentation: ____________________________________________________, 20____

PLEASE RETURN FORM TO: __________________________________________________________ PTA/PTSA

____________________________________________________________________________________________

Sept. 2005

California State PTA Toolkit – 2013

301

Honorary Service Award Nomination Form For Unit, Council And District Ptas