Please note:  City Hall and most departments/facilities will be closed from December 23rd through January 2nd. We will resume all services on Tuesday, January 3, 2023.

Public Service Award Nomination Form

  • Thank you for nominating someone to receive San Rafael's Public Service Award! While completing this nomination form, please provide as much information as possible to allow the selection committee to make the most informed decision possible. The selection committee may not know the person you are nominating, so please be descriptive in your answers.
  • Date Format: MM slash DD slash YYYY
  • Nominee for Public Service Award * Required
  • Nominee's Home Address * Required
  • Does this nominee live within San Rafael City Limits? * Required
  • Your Name * Required
  • Your Address * Required
  • When answering the questions below, please provide as much information as possible to allow the selection committee to make the most informed decision possible. The selection committee may not know the person you are nominating, so please be descriptive in your answers.
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