Page | 1

2014BoatU.S. Distinguished Civic Service Award Application

DEADLINE: 15 October 2014 to the R/C National Membership Committee

ACTIVITY PERIOD: 01 October 2013 to 30 September 2014

SQUADRON: orDISTRICT: ENTRY, please check one.

SQUADRON NAME: / DISTRICT #

CIVIC SERVICE ACTIVITIES: to be completed by the applicant

DESCRIPTION: include number of members involved and estimated total cumulative man-hours

  1. Short Term Local Community Activity
/ # Members / # Hours
(I.e. Day Events like Adopt-An-Environment, marine clean-ups, race day escorts, etc.)
  1. Long Term Local Partnership Projects
/ # Members / # Hours
(I.e. On-going partnerships: Sea Scouts, USCGAux, Brunswick, SERAT, boater alliances, etc.)
  1. Promotion of Boating Safety in Community Events
/ # Members / # Hours
(I.e. Parade floats, boat parades, community walks, fairs, etc.)
  1. Representing Squadron or District on Public Boards
/ # Members / # Hours
(I.e. On state/local committees and boards and not acting for any other organization)
  1. National Safe Boating Week Program(s)
/ # Members / # Hours
  1. Boat Show or Other Public Fairs Exhibition Booth(s)
/ # Members / # Hours
  1. Boating Safety and USPS Presentations to organizations
/ # Members / # Hours
(I.e. Rotary, Kiwanis, Chamber of Commerce, other community programs, etc.)
  1. Family or Youth Days – Promoting Boating Safety
/ # Members / # Hours
(I.e. School assemblies, poster contests, on-the-water outings for those in need, Jamborees, etc.)
  1. Radio/TV Show Appearances Promoting Boating Safety
/ # Members / # Hours
  1. Boating Safety Articles Written and Published during year
/ Quantity
  1. Social Media Sites Developed and Maintained – USPS brand apparent
List all addresses or paths to the sites so judging committee can review: / Quantity
  1. Please include one (1) sample of each activity either in hard or electronic copy; photograph.

  1. Prepare a one (1) page summary of how the civic service accomplishments benefitted the community and squadron this year. Include this with the application submission.

USPS® NATIONAL REPORT DATA: to be completed by the Judging Committee

  1. Squadron Membership as of 30 September 2013:
/ 30 September 2014:
  1. ABC3 Classes Conducted per Education Department:
/ # of Classes:
  1. USPS Seminars Conducted per Education Department:
/ # of Seminars:
  1. Vessel Safety Checks:
/ # VSC Performed: / # VS Examiners:
  1. Cooperative Charting Program:
/ NOAA Score:
  1. USPS Distinctive Communicator Award:
/ Newsletter: / Yes/No / Website: / Yes/No
  1. Achievement in Membership Outreach or Created Outreach Materials

APPLICATION SUBMITTED BY:

RANK:

/

NAME

/

GRADE:

Squadron/District Position:
Contact Information: / Email: / Phone # / ()-
Yes, I have read the detailed explanatory companion document: / (please initial)

SEND APPLICATION, SAMPLES, and SUMMARY SHEET TO: deadline 15 October 2014

R/C Mary Paige Abbott, SN-IN

5438 Shearwater Drive

Sanibel, FL 33957-2326

DATE APPLICATION RECEIVED: