Rotary Service Above Self Award Nomination Form

Rotary “Service Above Self” Award Nomination Form

Name of Person Nominated:______________________________ Date:__________

Address:______________________________________________

Nomination Made by:____________________________________

Contact information for yourself (email/phone):________________________________

This award is given to an individual who has demonstrated through his/her volunteer work in the Waseca area community that they exemplify the Rotary “Service Above Self” distinction in contributing to the betterment of the Waseca area and to the people of the Waseca area.

Please provide an overview of the service area(s) that this individual has volunteered in and specify the work completed that exemplifies the Rotary ‘Service Above Self” criteria including the number of years of service to the community (this can include specific participation of the individual, leadership provided, etc.):

Please address the impact to individuals and/or community that can be directly attributed to this individual’s contribution:

Other information (you may include information on family, employment, other volunteer activities of the individual, or other attributes that attest to this individuals character):