The Governor’s Volunteer Service Awards
Building Stronger Communities Through Service
2018 Nomination Form
Due: February 16, 2018
Commission Use Only: ______
ALL FIELDS ARE REQUIRED
Nominee Information:
Name:
Address: City/State/Zip:
Phone: E-mail:
County: Date of Birth (mm/dd/yy):
Where Service Was Performed:
Organization:
Address: City/State/Zip:
Phone: E-mail:
County:
Nominator Information
Name:
Address: City/State/Zip:
Phone: E-mail:
County:
Are you the immediate supervisor of the volunteer being nominated? Yes No ___
* If not, immediate supervisor is:
Select oneaward category in which the nominee’s volunteer service most closely aligns:
The Governor’s Volunteer Service Awards
Building Stronger Communities Through Service
2018 Nomination Form
Due: February 16, 2018
Youth (18 & Under)
Adult (19-54)
Senior (55+)
AmeriCorps Member
Senior Corps Member
Business
The Governor’s Volunteer Service Awards
Building Stronger Communities Through Service
2018 Nomination Form
Due: February 16, 2018
Select onefocus area in which the nominee’s volunteer service most closely aligns:
The Governor’s Volunteer Service Awards
Building Stronger Communities Through Service
2018 Nomination Form
Due: February 16, 2018
Disaster Services/Public Safety
Economic Opportunity
Education
Environmental Stewardship
Healthy Futures
Veterans and Military Families
The Governor’s Volunteer Service Awards
Building Stronger Communities Through Service
2018 Nomination Form
Due: February 16, 2018
County in which most service took place: ______
Please complete the final questions and limit your responses to 200 words for each question.
Community Need(s): How has the nominee met an identified community need through volunteer service? Please be sure to cover the following: state the community need and make sure it is clearly documented, convincing, or self-evident; tie the community need directly to the focus area chosen above (i.e. Disaster Services/Public Safety, Economic Opportunity, Education, Environmental Stewardship, Healthy Futures, or Veterans and Military Families).
Innovation: What innovative approach did the nominee take to meet the need(s) of the community? Please be sure to cover the following: clearly state the innovation; show that the activities reflect innovative or unique approaches to solving a community problem; show that the actions engaged unlikely partners or unusual alliances; highlight the nominee’s creativity and creative leadership; ensure the nominee’s actions contains an element of service-learning for the volunteer participants.
Impact: What was the impact of the nominee’s volunteer service on the community? Please be sure to cover the following:clearly state the impact; provide evidence of a coordinated/connected approach to problem-solving; provide evidence of a commitment to community service and leadership; show the nominee’s action waswell-planned and executed; show that other leaders in the community agree that the volunteer’s service reaped significant results.
Sustainability: What steps has the nominee taken to assure continued service delivery in the community? Please be sure to cover the following: clearly state the positive change from the nominee’s service; show the results of the nominee’s service reached farther or achieved greater results than intended; show the methods used can be reproduced, maintained, or sustained fairly easily; state that the impact helped reach a long-term solution to a problem, and/or will benefit the community for future generations.
Can this nomination be utilized for other Serve Illinois recognition programs such as Volunteer of the Week?
Yes No ___
NOTE: If applicant is selected for this or other volunteer recognition programs, bio and picture will be required to be submitted by the nominator.
APPLICATION INSTRUCTIONS AND GUIDELINES ARE AVAILABLE AT