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; be specific and explain how the nominee meets at least one of the criteria (listed below).

    • 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.

    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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