Public Service Award Nomination Form

Thank you for taking the time to nominate someone for Public Service Award! Your responses will help the selection committee learn more about this amazing person and the impact they’ve had on our community. Since the committee may not know them personally, please share as many details as you can to highlight their contributions.
Nominee for Public Service Award * Required
First Last
Nominee's Home Address * Required
Street Address City ZIP / Postal Code
Does this nominee live within San Rafael City Limits? * Required
- Yes
- No
Nominee's Phone
Nominee's Email
Your Name * Required
First Last
Your Address * Required
Street Address City ZIP / Postal Code
Your Phone * Required
Your Email * Required
What actions or initiatives has this person led or participated in to support our community? * Required
What lasting impact or positive change has resulted from their efforts? * Required
In what ways have they shown dedication, creativity, and passion in serving the community? * Required
What obstacles did this person experience on their path to achieving this accomplishment, and how did they push through? * Required
Has this person been recognized for their efforts before? If so, how? * Required
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