Service Program Awards Entry Form

Deadline for nominations to be considered at the upcoming State Convention is March 1.
Category*
- Faith
- Family
- Community
- Life

Project Information
Project Title*
Date*
Date Format: MM slash DD slash YYYY

If multiple dates, use the first occurrence
Participation:
Participating Members*
Members
Participating Non-Members*
+ Non-Members
Total Participants*
= Total Participants
Total Participants 2*
Total Participants
Hours*
x Hours
Total Volunteer Hours*
= Total Volunteer Hours
Program Planning:
Program Planning Costs
Costs
Program Planning Time*
Time (indicate in hours)
Members Recruited*
Donations*

Purpose and Goals*
In the space provided below, briefly describe the purpose and goals of this program.
Whom does this project benefit?
What problem or need did this project resolve?
Why did the council select this project?
Describe the success of the project:
Supplementary Material
Supplementary material may be submitted along with the nomination. Accompanying materials can include letters, testimonials, news clippings, photographs, pamphlets, etc. Do not submit tapes, videocassettes, dvd’s, display materials, films, etc., as they will not be considered in judging the nomination.
Uploaded File(s)
Drop files here or
Online supplementary materials
If these items are online, list the links in this box.

Council Information