Rotary Club of Madison

2 S. Carroll Street, Suite 255, Madison, WI 53703

Phone (608) 255-9164 Fax (608) 255-9007

E-mail:

SENIOR SERVICE AWARD NOMINATION FORM

Candidate’s Name:Date:

Is the candidate at least 65?Yes No

If No, what are the exceptional circumstances that merit special consideration?

RECOMMENDED BY:

(Your name)

Basis for Award

Per board approved criteria as indicated, include organization(s) and if possible, related time frame:

  • Volunteerism through non-profit programs or organizations (indicate populations that have benefited if not self-explanatory):
  • Primary focus – betterment of Madison or Dane County; activities that benefit a broader level of society may also be considered:
  • Significance of contribution(s) in terms of impact (particularly important to demonstrate if volunteer contribution is of short duration):
  • Special consideration is given to “unsung heroes”; this does not preclude an award to individuals who have received recognition for volunteer service contributions.

Other Information – Briefly indicate any special circumstances or relevant information not already indicated for the committee to consider:

(For Committee Use Only)

Award Approved: Yes □ No □Date of Action: ______

Committee Person Assigned: ______

Date Award Scheduled For Presentation: ______

\Committees\Senior Service\Senior Service Nomination Form 2013.doc

ROTARY CLUB OF MADISON

SENIOR SERVICE AWARD

Purpose and Criteria

Purpose

Senior Service Award recognition is given to individuals, couples or senior groups who have contributed significant amounts of civic or social service to the local community or to society in general. Except in unusual circumstances, candidates for the award must be at least 65 years of age and through their efforts represent and foster the Rotary ideal of “Service above Self.”

Criteria

The award focuses on civic or social volunteer activities and contributions in the community and for the betterment of society. This includes volunteerism through any non-profit program or organization.

The primary focus of service for consideration is the betterment of Madison or DaneCounty. However, activities that benefit a broader level of society may be also be considered.

Volunteer efforts may be of long or short duration, on behalf of one organization or multiple organizations but if of short duration, the contribution must be significant in terms of its impact. The candidate review and deliberation process will include consideration of the scope of the activities and the degree of significance and impact.

Special consideration is given to “unsung heroes,” those whose contributions may otherwise go unrecognized. The Senior Service Award provides a unique opportunity to convey appreciation and recognition in such circumstances. This does not, however, preclude an award to individuals who have received recognition for significant volunteer service contributions.

Revised 10/7/13