Local Government Honor Roll Nomination Form

NOMINATE A PUBLIC SERVANT

There are two ways to nominate someone for the Local Government Honor Roll:

• Fill out the online Nomination Form at the bottom of this page and click on the "Submit" button.

• Download the printable PDF version of the Nomination Form by clicking on the link to the left and submit it by fax (847-234-8309), or by mail (PAR Public Service Foundation, 100 N. Waukegan Road, Ste.211, Lake Bluff, IL 60044-1694).

There are two sections to the Local Government Honor Roll Nomination Form: The first section is the Nomination Form itself. Please fill it out to the best of your ability. (To see an example of what a Nomination submission should look like, please click on Paul A. Reaume.) The second section is the Supplemental Nomination Form. This is an opportunity for you as the Nominator to submit additional information regarding your Nominee. It can also be used by the Nominee to supplement the information you have submitted with more detailed and personal information than the Nominator can supply.

In addition to submitting the Nomination Form (and Supplemental Nomination Form, if you or the Nominee wish to do so) we invite you to submit a picture of the Nominee to be included on the PAR Public Service Foundation website. We also invite you to submit an additional picture or two which illustrates one of the contributions of the Nominee to their community (e.g., a public building that is named after them; a park they helped develop; a major capital improvement that they had a role in bringing into reality; a new industry they helped bring to town; or any other picture which depicts a contribution made by the Nominee to their community). Pictures can be e-mailed to honor_roll@pargroupltd.com or mailed to the PAR Public Service Foundation at the above address. Please be advised that any pictures submitted for inclusion will not be returned to you or the Nominee.

ONLINE LOCAL GOVERNMENT HONOR ROLL NOMINATION FORM
I nominate to be included on the Local Government Honor Roll.
I nominate this person for the following reasons: (Please write a narrative of why you think this person should be recognized and listed on the Honor Roll.)
NOMINEE INFORMATION
Name:
Address 1:
Address 2:
Phone: Fax: E-mail:
Nominee Is Deceased? YES NO
YOUR INFORMATION
Name:
Address 1:
Address 2:
Phone: Fax: *E-mail (Required):
SUPPLEMENTAL NOMINATION FORM PLEASE FILL OUT TO THE BEST OF YOUR ABILITY. LEAVE UNKNOWN FIELDS BLANK.
Nominee's Public Service Positions, Organizations & Activities, Professional Positions, Appointed Boards & Commissions, Political Offices & Candidacies: (Include years of service if possible)
Nominee's Education:
Nominee's Reasons For Choosing Public Service as a Career or Commitment:
Nominee's Major Accomplishments & Success Stories:
Favorite Public Service Story or Anecdote Regarding the Nominee:
THE PAR PUBLIC SERVICE FOUNDATION RESERVES THE RIGHT TO MAKE THE FINAL DETERMINATION AS TO WHETHER A NOMINEE IS INCLUDED ON THE LOCAL GOVERNMENT HONOR ROLL. BY SUBMITTING THIS INFORMATION TO THE PAR PUBLIC SERVICE FOUNDATION, THE NOMINATOR RECOGNIZES THAT THIS INFORMATION MAY BE PUBLISHED ON THE FOUNDATION’S WEBSITE AND MAY BE INCLUDED IN OTHER MEDIA PRESENTATIONS BY THE FOUNDATION.