Council Approved Recognitions Nomination

COUNCIL-APPROVED RECOGNITION NOMINATION FORM

Name of Candidate

Address

City

State

Zip

Day Phone

Evening Phone

District

Neighborhood

Registered Member?

Award for which candidate is recommended

Current position in Girl Scouts

Describe the service and/or accomplishment(s) for which you view the candidate worthy of recognition

Describe the impact and results of the candidate’s actions

List specific audience(s) benefiting from service

Candidate's previous Girl Scout position(s)

List other background, community roles and services, if relevant

List names and positions of individuals submitting letters of endorsement

Signature

GSEM is a proud United Way member and is supported by the following United Way Agencies: United Way of Greater St. Louis, United Way of the Mark Twain Area, United Way of Adair County/Northeast Missouri, United Way of St. Francois County, Franklin County Area United Way