Waukesha Rotary Club’s

SERVICE ABOVE SELF AWARD

Nomination Form

Due on or before April 30, 2018 to Club President

This award recognizes non-Rotary members (individuals or organizations) who exemplify the Rotary motto of Service Above Self. The Service Above Self Award is presented at the Changing of the Guard Banquet and Program held in June each year. The Waukesha Rotary Club will provide two seats for the event for the Recipient and a guest. A grant of $250 will be given from the Waukesha Rotary Charitable Foundation to a 501 (c) 3 organization of the Recipient’s choice, provided that the organization aligns with the values of Rotary International.

Recipient will be asked to provide information for a media release to local and regional outlets and may be asked to be available for an interview with a member of the media, and a member of the Waukesha Rotary Club’s Public Image Committee. Recipient may be invited to give a presentation to the Waukesha Rotary Club.

Priority will be given to those individuals or organizations who are active in any of the six international areas of Rotary focus or three local areas of focus for the Waukesha Rotary Club.

International Areas of Focus

  1. Promoting peace within and across cultures
  2. Fighting disease including polio, HIV/AIDS, and malaria
  3. Providing clean water, sanitation, and hygiene
  4. Saving mothers and children
  5. Supporting education
  6. Growing local economies

Local Areas of Focus

  1. Education
  2. Basic Needs
  3. Economic Development

Nominator:

  • Must be a current member of the Waukesha Rotary Club or a member of an Interact Club within the School District of Waukesha.
  • Should consider the 4-Way Test in determining the information for the nomination:
  • Is it the truth?
  • Is it fair to all concerned?
  • Does it build good will and better friendships?
  • Is it beneficial to all concerned?

Nominee:

  • must demonstrate Service Above Self with an emphasis on volunteer efforts or organizational service efforts. (Financial contributions are not relevant for this award.)
  • may not be a Rotarian (either individual or corporate).
  • Individual nominees must live or work in the Greater Waukesha area.
  • Organizational nominees must have a physical location in the Greater Waukesha area and/or provide services to the Greater Waukesha area.

Nominator Information:

Name
Email address:
Phone number:
Active Waukesha Rotary Club member? / Active member of an Interact Club?

Nominee:

Individual?
Organization?
Name
Organization
Email address
Phone number
Address
City, State, Zip Code

In what area does the nominee provide Service Above Self?

International Areas of Focus

Promoting peace within and across cultures

Fighting disease including polio, HIV/AIDS, and malaria

Providing clean water, sanitation, and hygiene

Saving mothers and children

Supporting education

Growing local economies

Local Areas of Focus

Education

Basic Needs

Economic Development

Please provide information about the nominee’s activities: (you may attach additional information including brochures, website references, or other information)

Process

Time / Activity / Responsible Party
January – April / Solicit nominations from Waukesha Rotary Club and Interact Clubs / Public Image Chair, Club President
April 30 / Nominations due to Club President / Club members, Interact Members
May / Selection Committee determines Award Recipient / Club President, Foundation President, Public Image Chair, up to two additional Club members as determined by the Club President
Club Administrator notifies Recipient and Nominator / Club Administrator
May – December / Media contacted for story, information posted on Club website / Public Image Chair
June / Award presented at Changing of the Guard Dinner / Public Image Chair, Club President
June / $250 grant made to charity selected by Recipient, approved by Foundation President / Foundation President
July – December / Recipient may be invited to give presentation at a club meeting / Public Image Chair, Club President