Girl Scouts of Washington Rock Council, Inc.

Adult Recognition

Nomination Form

IMPORTANT: Please read all instructions prior to completing this form.

Date submitted ___________________ Date received __________________

Deadline for all completed forms with endorsements attached is the third Friday in January. Notification of approval or denial will be sent to the nominator in mid-March. Typewritten applications are strongly encouraged. Applications and letters of endorsement must be legible.

The award candidate is being nominated by:

Name ______________________________________

Girl Scout Position __________________________________________

Street, Town, Zip  ________________________________________________________

Phone (day) _______________ Phone (eve) _______________

The candidate is being nominated for the following award:

_____Appreciation Pin

_____Honor Pin

_____Thanks Badge

_____Thanks Badge II

_____Emerald Award

_____15+ Years of Service

_____25+ Membership Numerals

_____Community Award

(note: President’s Award Application Forms are available separately at the council service center.)

Candidate Information

Name ______________________________________________________________________________

Address ______________________________________________________________________________

______________________________________________________________________________

GS Community _________________________________________________________________

Candidate’s present position(s) in Girl Scouting:

____________________________________ ___________________________________

____________________________________ ___________________________________

____________________________________ ___________________________________

Candidate’s previous position(s) in Girl Scouting (including dates):

____________________________________ ___________________________________

____________________________________ ___________________________________

____________________________________ ___________________________________

Girl Scout Awards/Recognitions the candidate has received (award date(s) if possible):

____________________________________ ___________________________________

____________________________________ ___________________________________

____________________________________ ___________________________________

Award Rationale

Describe the service of the candidate which fulfills the criteria for the award for which she/he has been nominated. Information must be typed or printed legibly. Be specific; the decision of the Adult Recognition Committee is based upon what is written on this application and in attached endorsements. Include dates, clear and concise descriptions, references when available, and the impact this candidate has had in Girl Scouting and the service unit. You may continue on a separate page if necessary.

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Signature of person completing this nomination form _________________________________

Date ____________________________

Revised 10/98 a: rec97/TB/a&rnom.doc