GSWPA VOLUNTEER OF THE YEAR AWARD
NOMINATION FORM
Please provide detailed, specific and accurate information, including listing qualifications and
particular instances. The information provided may be used in the presentation of the award.
Attach ONE additional sheet if necessary. Each nomination should include FOUR references
with current contact information. Forms must be submitted for consideration by February 1.
When completed, forward this nomination form to ATTN: ADULT AWARD-Volunteer of the Year
GSWPA, Johnstown Office, 612 Locust Street, Johnstown, PA 15905 or [email protected]
Please include a current, high quality photo of your nominee.
NOMINEE INFORMATION
Name of nominee:
Address:
Street
City
Phone-Day:
Phone-Cell:
Service Unit:
Current position(s) held in Girl Scouting:
Total number of years as a Girl Scout volunteer:
The nominee:
Works directly with girls
State
Zip
Phone-Evening:
Troop # (if applicable):
Works indirectly, working with adults
Previous awards earned by nominee:
She/he is a role model for other volunteers because:
Please describe major accomplishments in the previous service year that have helped others in the council
(i.e., mentoring, etc.) and how she/he has gone beyond the requirements of her position to deserve this award:
Describe how she/he has made a positive impact on her community and the Council:
Why do YOU feel this nominee should receive the GSWPA Volunteer of the Year Award?
OVER
Updated 5/30/13
129