2017 Governor's Service Awards Nomination … · Download a SAMPLE form/document with the ... Creating Lasting Change and Demonstrating Community Impact: How has the Nominee produced

Nominations are welcome for individuals or organizations that have provided outstandingvolunteerism and service for a variety of activities or by focusing on one issue of primary

importance.

Nomination Instructions and Form

2017 Governor's Service Awards

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PART I. AWARD CATEGORIES

A. Individual Awards (recognition for service that is not part of a paid position)

1. Governor George Romney Lifetime Achievement Award

An individual, usually an older adult, who has taken their volunteer service to the highest level.This individual demonstrates a lifelong commitment to community involvement and volunteer service.He/she is highly regarded for making a tremendous impact in their community or the state.

2. Lifetime Humanitarian Award

An individual or family that has demonstrated a lifetime of outstanding civic and charitableresponsibility to a community or organization.This individual or family is a role-model and exhibits selfless commitment to the community andtireless actions which may include significant monetary contributions, serving on community board(s),and/or leading major community projects.

3. Senior Volunteer of the Year Award

Individuals 65 or older who are taking action to make their community a better place.These individual share their many years of experience and are role models for others to serve andvolunteer.

4. Volunteer of the Year Award

Individuals over the age of 25 who strive to improve the lives of people in their community.These individuals make impact through volunteering in various capacities with nonprofits andorganizations with the goal of improving the lives of people and supporting communities.

5. Youth Volunteer of the Year Award

Individuals age 25 and younger who work hard to make an impact.These individuals create solutions to make lives better and demonstrate the spirit of being changemakers.

6. Mentor of the Year - Youth Support Award

Individuals who provide youth (25 and under) with the confidence and assets to be successful. These individuals tirelessly offers guidance, support, and encouragement to cultivate the positive andhealthy development of an individual or group of youth.

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B. Organization and Business Awards

1. Outstanding Volunteer Organization Award

Service Club, Nonprofit, Faith-based, Veteran, Disaster Preparedness, or other organization thatmakes a demonstrated difference in their community or the state by inspiring people to volunteer.

2. Education Service Leader Award

Schools, Colleges/Universities, or other organizations that support youth making a difference andlasting impact in their communities.

3. Outstanding National Service Program Award

AmeriCorps State, AmeriCorps VISTA, AmeriCorps National, Senior Companions, FosterGrandparents, RSVP programs successfully making an impact in communities and supporting theirservice members.

4. Corporate Community Leader (100+ employees) Award

Corporations/Businesses that are committed to making a difference in their communities and/or thestate.This commitment must include supporting employees to volunteer and can also include formalvolunteer programs, monetary contributions, in-kind gifts, and employee-driven volunteer service.

5. Small Business Community Leader (<100 employees) Award

Businesses that are committed to making a difference in their communities and/or the state.This commitment must include supporting employees to volunteer and can also include formalvolunteer programs, monetary contributions, in-kind gifts, and employee-driven volunteer service.

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PART II. NOMINATION INSTRUCTIONS

A. Decide Who to Nominate

The goal of the Governor’s Service Awards is to recognize outstanding and extraordinary volunteerservice efforts by individuals and organizations. Nominees are selfless individuals and organizations who volunteer and serve to make an impact incommunities in the State of MichiganAll completed nomination applications will remain active for 2 years.

B. Select the Award Category

Review the Award categories and select the one that best matches your nominee.Once the appropriate category has been chosen, familiarize yourself with the information that needsto be provided in the application and answer all the narrative questions as completely as possible.

C. Complete the Application

Applications are due by close of business on Monday, March 20, 2017.Provide as much relevant information as possible about your Nominee. Your application tells the storyof why your nominee deserves to be honored as one of the outstanding volunteers in Michigan.You are strongly encouraged to first prepare your responses to questions in a sample document andthen simply cut and paste text into the online application. Download a SAMPLE form/document with the nomination questions here: SAMPLE 2017 GSANomination Form A hard copy of the nomination form is available upon request.

D. Submit Supporting Documents

We strongly encourage you to submit supporting documents. These materials help strengthen yournomination and often offer the extra element your nomination narrative needs.Examples include: letters of support from the community and those who were served, news articles,and any other items that demonstrate the Nominee’s commitment to service.There will be an opportunity to upload your supporting documents at the end of the onlineapplication. Please keep in mind supporting materials will not be returned to you.

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http://www.michigan.gov/documents/mcsc/2017_GSA_Nomination_Form_550515_7.pdf

PART III. SELECTION PROCESS

All nominations go through an extensive review process that involves a volunteer Peer Review Panel.The Michigan Community Service Commission Board of Commissioners and the Office of theGovernor make the final selections.Up to five awards will be made in each category, except for the Governor George Romney Award, forwhich there is only one awardee.Awardees and their nominators will be notified in May 2017 if they have been selected as aGovernor’s Service Award Recipient.To honor the recipients, Governor Snyder will present the awards during a celebration that will takeplace on August 21, 2017 in Detroit.The honoree or an agreed upon representative needs to be present to receive the award.During the review process, you will be contacted if you need to provide additional informationincluding a Nominee signed background check form and digital photos of the Nominee.

Please visit www.michigan.gov/GovernorsServiceAwards for detailed guidelines.

If you have any questions or need additional information, please call the Michigan Community ServiceCommission

at 517-335-4295 or email [email protected]

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Nominator Information


Nominator Name (include your title if applicable)

Organization (if applicable)

Address:

Address 2:

City

State: -- select state --

ZIP:

Email Address:

Daytime Phone Number (123-456-7890)

1. Nominator Contact Information*

2. What is your relationship to the Nominee?

Family Member

Friend

Neighbor

Fellow Volunteer

Co-Worker

Supervisor

Employer

Board Member

Member of Organization/Business

Other (please specify)

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3. Are you nominating an Individual or Organization/Business?*

Individual or Family

Organization or Business

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Nominee Name (include title if applicable)

Organization (if applicable)

Address:

Address 2:

City

State: -- select state --

ZIP:

Email Address:

Daytime Phone Number (123-456-7890)

4. INDIVIDUAL AWARD QUESTIONS*

5. List the community(ies) and county(ies) in which the Nominee serves/volunteers:*

6. What is the age of the Nominee?*

25 or under

26-64

65+

7. Select the award for which the INDIVIDUAL is being nominated?

George Romney Lifetime Achievement Award

Senior Volunteer of the Year Award

Volunteer of the Year Award

Youth Volunteer of the Year Award

Mentor of the Year Award

Lifetime Humanitarian Award (this may be individual or family)

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8. Volunteer Service:List the following information for EACH of the volunteer activities in which the Nominee hasparticipated throughout their lifetime. This could include volunteering with nonprofits, serving on boards,supporting or leading projects or programs, or raising money for projects. The Nominee may have beeninvolved in many activities or volunteered significant time to one particular cause.

Name of Organization or Project and Location (example: Elks Sports Mentoring Program in TinyTown, MI)Dates of Service (example: 2001-2016)Approximate Number of Hours of Service in this time period (example: 4,500 hours)How many people have been impacted by the nominee’s volunteerism/service?Describe Volunteerism/Service Provided (example: Mentored 3 different youth consistently for 8years, served on various community boards for 10 years)Description of Impact made as a result of service for individual(s) or community(ies).

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9. Tell the Story of the Nominee – Why should the Nominee receive a Governor's Service Award?

You must provide answers for the following two categories in your narrative. Use the questions below as aguide.

Providing Volunteerism/Service:

What is unique about the Nominee's service that is deserving of recognition?When did the Nominee first begin to volunteer?What motivates the Nominee to volunteer?How has the Nominee been an inspiration for others to volunteer/serve?

Creating Lasting Change and Demonstrating Community Impact:

How has the Nominee produced lasting change for an individual, organization, or community?What creative solutions did the Nominee use to support an individual, organization or community?If serving youth, how have the youth improved? (e.g. grades, attendance, developed future goals,etc.)What would the community say about the Nominee's serviceProvide any quotes from individuals who were served by the Nominee.What resources has the Nominee secured for an individual, program, or community?How much money has the Nominee raised to support causes?

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10. Complete this Question for Governor George Romney Lifetime Achievement Award:

What motivated the Nominee to remain involved in volunteerism/service throughout their life and whatcontinues to motivate this individual?Approximately how many lifetime hours of service has the Nominee provided?What is the significance of the Nominee's service?

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Organization and Business Nominations


11. For which Award are you making a nomination?*

Outstanding Volunteer Organization Award

Education Service Leader Award

Outstanding National Service Program Award

Corporate Community Leader Award (100+ employees)

Small Business Community Leader Award (<100 employees)

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12. Tell the Story of how the Organization or Business has made an impact. You must provide answers for the following two categories (A & B) in your narrative. Use the questionsbelow as a guide.

A. Supporting Individuals to Volunteer/Serve

How has the Nominee assisted and encouraged individuals to serve?How many individuals did the Nominee engage in volunteering/service?Approximately how many hours did the volunteers serve?What motivates this Organization or Business to support volunteerism?How has the program successfully supported it’s national service members? (Required for national

service programs)

B. Creating Lasting Change and Demonstrating Community Impact

How has the Nominee produced lasting change and/or demonstrated community impact?What is unique about their service that is deserving of recognition?If serving youth, how have the youth improved – grades, attendance, future goals?What creative methods did the Nominee use to solve a challenging issue in the community?What would the community say about the service of this Nominee?Provide any quotes from individuals who were served by this Nominee.How much money has the Nominee raised or provided to support causes?What resources has the Nominee secured for programs or nonprofits?

*

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13. Volunteer Service Provided

List the following information for the service activities the Nominee has provided to communities inMichigan. This could include volunteering/serving with nonprofits, supporting or leading projects orprograms, providing funds for projects, creating solutions to community challenges or providing resources.The Nominee may have been involved in many activities or dedicated significant time to one particularcause.

Name of Organization or Project and Location (i.e. 7-11 Mentoring Program – Tiny Town).Service/Volunteerism Provided (i.e. created new youth mentoring program to teach youth workplaceskills and motivating them to attend school and excel).Dates of Service (i.e. September 2016 - Present).Number of Volunteers and hours served (i.e. 55 employees - 1,200 hours).Number of Individuals Served (i.e. 125 youth).Amount of resources provided (i.e. $1 million over five year period).Description of project(s), what resources were provided, and impact made as a result of service forindividual(s) or community.

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Reference #1 - Name & Title if applicable

Relationship to Nominee

Main Phone Number (123-456-0000)

Email Address

Reference #2 - Name & Title if applicable

Relationship to Nominee

Main Phone Number (123-456-0000)

Email Address

14. Please provide two references familiar with the Nominee’s volunteer activities. References MAYNOT be the Nominator, Nominee, or someone RELATED to the Nominee. Please inform the referencesthey will be contacted if the Nominee advances beyond the first review.

*

Nominator Signature:

Today's Date:

15. Certification of the Nomination ApplicationPlease type your name and today's date below certifying that all the information contained in thisapplication is accurate and true to the best of your knowledge.

Nominator Name & Title:

Today's Date:

16. Certification of Organization/Business Application (If applicable)If the Application was not completed by a staff member at the Organization or Business being nominated,you must provide the organization with a copy of the application submitted for their review. Ask them toprovide you with any additional information that will more accurately reflect their service and commitment tothe community and/or state.

The Nominee must submit on their letterhead the following statement for you to attach to the application:

I certify that I have read the application and that it accurately reflects and contains all of the informationabout the volunteerism/service of our organization/business.

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Please use hyperlink, complete form and upload when complete

No file chosen

17. 2017 GSA Background Check Form

Choose FileChoose File

No file chosen

18. Certification on Organization/Business Letterhead (if applicable)


No file chosen

19. Upload news article


No file chosen

20. Upload Letter of support


No file chosen



No file chosen



No file chosen

23. Upload photo


No file chosen

24. Upload photo


No file chosen

25. Upload photo


No file chosen

26. Upload photo


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http://www.michigan.gov/documents/mcsc/2017_GSA_Background_Check_Form-_Fillable_550311_7.pdf

Thank You For Your Nomination!


Thank you for submitting your nomination for the 2017 Governor's Service Awards.

Remember to upload the background check form, photos, news articles, and letters of support by the application deadline(COB Monday, March 20, 2017).

Nominations will be reviewed during March and April 2017. Winners and their nominators will be notified in May 2017. An awardcelebration will be held August 21, 2017 in Detroit. Further event details will be announced soon.

For more information or assistance, please contact the Michigan Community Service Commission at (517) 335-4295 or [email protected]

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