Council Level Recognition Nomination Form Our recognition ceremony recognizes those volunteers who provide exemplary service and go above andbeyond the expectations of their position to make a difference for the organization and for Girl Scouts. This form is to be used to nominate an adult volunteer for a council level recognition award. The nomination is for the work performed during the 2024-2025 membership year. Nomination Steps: Decide which award is appropriate for the service.▪Refer to the reference sheet to determine impact of service.▪ Include specific information that relates to the service and its scope of impact.▪ Gather candidate’s contact information including address, phone number, email, and service unit.▪ Submit nomination only through council’s eForm. Gather the contact information of those people providing supporting endorsements. ▪ Notify the contacts that you have submitted their information to support the nomination.▪ Provide their contact information such as name, email address, and phone number.▪ Supporting endorsements vary by award. Please enter appropriate number of contacts to fulfill this requirement.▪ Supporting endorsements must be from someone other than the person submitting the nomination. Submit the nomination via eForm.▪Deadline to submit is the first Friday in December.▪ Supporting endorsements will receive an email to submit by second Friday in December via eForm.▪ Nomination should remain a secret from the candidate in case the nomination is not approved. Contact adultrecognitions@girlscoutsla.org if you have any questions. Application Date Nominee Information Nominee Name * Nominee Position: VolunteerIndustry ExpertCommunity PartnerOrganization Leadership Nominee Position: Mailing Address * Phone Number * Email Address * Confirm Email Address * Nominee Region * North – Antelope Valley North – Canoga Park North – Santa Clarita Valley Southeast – Arcadia Southeast – Upland Southwest – Inglewood Southwest – Long Beach test2 Is the nominee associated with a service unit? * Yes No Unsure Service Unit Alamitos/Marina Alhambra/Rosemead/Santa Fe Trails Anita Oaks/Mission Camellias Bellflower/Hollymount Belmont Bonita Burbank Campo Verde Canon Trails Canyon Star Center City Chino Chino Hills Claremont Compton/Lynwood Covina Oaks Coyote Canyon Crown Poppy Culver City CV/Glendale East LA El Segundo Gateway Glendora Golden Savannah Heart of the Valley Heritage Committee Highland Rose Holly Hills Kern King Harbor La Brea Heights La Canada Lachen Lakewood Lancaster Las Caballeras Las Virgenes Lawnthornes Magnolia Manhattan Beach Marina Mission Rose Monrovia/Duarte Mountain View North Redondo Beach North River Northeast Hills Ontario/Montclair Palisades/Malibu Palmdale/Acton/Agua Dulce Pomona Puente Hills PV/Penn Rancho Calabasas Rancho Foothills RDE/Sil-Dom River Trails Robotics Team Sagebrush San Marino San Pedro Santa Monica Bay South Bay Four South Pasadena South Torrance Southeast Stoneyridge Testing Only – Do Not Use Torrance Twin Oaks Upland West Covina Westchester/Del Rey Westside Woodland Hills Submitter Information Name * Present Girl Scout Position if Applicable Mailing Address * Phone Number * Email Address * Confirm Email Address * Region * North – Antelope Valley North – Canoga Park North – Santa Clarita Valley Southeast – Arcadia Southeast – Upland Southwest – Inglewood Southwest – Long Beach test2 Service Unit Alamitos/Marina Alhambra/Rosemead/Santa Fe Trails Anita Oaks/Mission Camellias Bellflower/Hollymount Belmont Bonita Burbank Campo Verde Canon Trails Canyon Star Center City Chino Chino Hills Claremont Compton/Lynwood Covina Oaks Coyote Canyon Crown Poppy Culver City CV/Glendale East LA El Segundo Gateway Glendora Golden Savannah Heart of the Valley Heritage Committee Highland Rose Holly Hills Kern King Harbor La Brea Heights La Canada Lachen Lakewood Lancaster Las Caballeras Las Virgenes Lawnthornes Magnolia Manhattan Beach Marina Mission Rose Monrovia/Duarte Mountain View North Redondo Beach North River Northeast Hills Ontario/Montclair Palisades/Malibu Palmdale/Acton/Agua Dulce Pomona Puente Hills PV/Penn Rancho Calabasas Rancho Foothills RDE/Sil-Dom River Trails Robotics Team Sagebrush San Marino San Pedro Santa Monica Bay South Bay Four South Pasadena South Torrance Southeast Stoneyridge Testing Only – Do Not Use Torrance Twin Oaks Upland West Covina Westchester/Del Rey Westside Woodland Hills Award Level Award(s) for Nominee * Membership and Service Pins Council and National Award Select Numeral Guard for: 30 years+ as a registered Girl Scout – girl/adult Select Years of Service for: 25 years+ as a registered Adult volunteer Membership and Service Pins * Numeral Guard Years of Service Select Numeral Guard and/or Years of Service Numeral Guard * 303540455055606570758085 Select the number of girl and adult years rounded down to an increment of 5 years. (For 5 – 25 years use Service Unit form). Years of Service Pin * 253035405060 Select the number of active adult only years rounded down to an increment of 5 years. Note, it goes up in increments of 10 years after 40 years. Council and National Awards * Appreciation PinHonor PinPlatinum Service AwardThanks BadgeThanks Badge IIHeart and Hand Pin Select the type of award this nomination applies to. Only one award per nomination. Describe how the candidate’s unique expertise contributed and demonstrated outstanding and meaningful service that had significantly benefited the council, region, or multiple service units. * Was the service provided beyond the Troop level? * Yes No * The Appreciation Pin requires service beyond the troop level, therefore this application will be denied. Please select another award level. Was the service provided to two or more Service Units? * Yes No * The Honor Pin requires service be provided to two or more service units, therefore this application will be denied. Please select another award level. Was the service provided to their Service Unit or a region or the entire council? * Yes No * The Platinum Service Award requires service be provided to their Service Unit or a region or the entire council for at least three years since receiving the Appreciation Pin and either Honor Pin or Thanks Badge, therefore this application will be denied. Please select another award level. Has the candidate taken a leadership role at the council level during the previous four years? * Yes No * The Thanks Badge requires service be provided in a leadership role at the council level in one or more areas during the previous four years, therefore this application will be denied. Please select another award level. Has the candidate received the Thanks Badge? * Yes No * The Thanks Badge II requires candidate has been awarded the Thanks Badge, therefore this application will be denied. Please select another award level. Nomination This nomination should remain a secret from the nominee in case the nomination is not approved Should this award be approved it will be presented at the Annual Meeting and Volunteer Recognition Ceremony. The recipient will be provided with a copy of the nomination and endorsements submitted. Recipients may be given their supporting nominations and application. The recipient will receive an invitation to attend the ceremony. The submitter will be notified of the committee’s decision. Appreciation Pin Please describe how the nominee has rendered service and benefited at least one Service Unit or program delivery audience (i.e. product program, membership etc…). Be detailed and as specific as possible listing qualifications and particular instances. Please be sure your answers support the above stated criteria to qualify for this award. You will be need to provide the name and email information of two people to support this nomination. 1. Describe the service rendered and who benefited. Include how the candidate actively recognizes, understands, and practices the values of inclusive behavior. * 2. How did this service significantly contribute to one or more council goals in membership growth and retention, fund development (including but not limited to alumnae, FFund Development, Product Program, etc…) or increased community visibility. * 3. Give the reasons this service was beyond expectations of the position held to provide outstanding service. * Honor Pin Please describe how the nominee has rendered service and benefited at least two or more Service Units or a Region. Be detailed and as specific as possible listing qualifications and particular instances. Please be sure your answers support the above stated criteria to qualify for this award. You will need to include the name and email of three additional people supporting the nominee’s service. 1. Describe the service rendered and who benefited. Include how the candidate actively recognizes, understands, and practices the values of inclusive behavior. * 2. How did this service significantly contribute to one or more council goals in membership growth and retention, fund development (including but not limited to alumnae, Family Partnership, Product Program, etc…) or increased community visibility. * 3. Give the reasons this service was beyond expectations of the position held to provide outstanding service. * Platinum Service Award Please describe how the nominee has rendered service and benefited a Service Unit, a Region or the entrie Council for three years after receiving the Appreciation Pin and either the Honor Pin or Thanks Badge. You will need to include the name and email of three additional people supporting the nominee’s service. Thanks Badge Please describe how the nominee has rendered service and benefited the entire Council or entire Girl Scout Movement. Be detailed and as specific as possible listing qualifications and particular instances. Please be sure your answers support the above stated criteria to qualify for this award. You will need to provide the names and emails of four additional people supporting the nominee’s service. Thanks Badge II Please describe how the nominee has rendered service and benefited the entire Council or entire Girl Scout Movement. Be detailed and as specific as possible listing qualifications and particular instances. Please be sure your answers support the above stated criteria to qualify for this award. You will need to provide the names and emails of four additional people supporting the nominee’s service. Year Appreciation Pin Awarded * 19601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030 Year Honor Pin Awarded 19601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030 Enter the year the Honor Pin and/or Thanks Badge were awarded. Year Thanks Badge Awarded 19601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030 1) Describe service rendered and how it benefited the Service Unit; include position title(s) and dates. * 2) Describe service rendered and in what way it benefited the Region or entire Council, include position title(s) and dates. * 1) Describe the service rendered and how the entire Council or Girl Scout Movement benefited. Include how the candidate has taken a leadership role at the council level during the previous four years in one or more of the following areas: membership, adult generated funding, innovative programs, influencing policy, inclusive behavior. * 2) Give the reasons this service was beyond expectations of the position held to provide outstanding service. * 1) Date the “Thanks Badge” was awarded * 2) Describe the service rendered and who benefited – GSGLA or GSUSA. Include how the candidate has taken a leadership role at the council level, increased the sphere of influence, or used skills and talents to move into another field of endeavor during the previous three years. * 3) Give the reasons this service was beyond expectations of the position held to provide outstanding service. * 4) In what way did this service set a positive example for others of what it means to be a Girl Scout adult. * Name of Supporting Nomination Contact #1 * Please enter the name of a person who is willing to support this nomination. Email address of Supporting Nomination Contact #1 * Please enter the email address of the person who is willing to support this nomination. Name of Supporting Nomination Contact #2 * Please enter the name of a person who is willing to support this nomination. Email address of Supporting Nomination Contact #2 * Please enter the email address of the person who is willing to support this nomination. Name of Supporting Nomination Contact #3 * Please enter the name of a person who is willing to support this nomination. Email Address of Supporting Nomination Contact #3 * Please enter the email address of the person who is willing to support this nomination. Name of Supporting Nomination Contact #4 * Please enter the name of a person who is willing to support this nomination. Email address of Supporting Nomination Contact #4 * Please enter the email address of the person who is willing to support this nomination. Name of Supporting Nomination Additional Contact #1 Optional: You can enter the name of an additional person who is willing to support this nomination. Email address of Supporting Nomination Additional Contact #1 Optional: You can enter the email address of the additional person who is willing to support this nomination. Name of Supporting Nomination Additional Contact #2 Optional: You can enter the name of an additional person who is willing to support this nomination. Email address of Supporting Nomination Additional Contact #2 Optional: You can enter the email address of the additional person who is willing to support this nomination. Submit By clicking yes, I’m acknowleging that I’ve entered all information correctly to the best of my knowledge. * Yes Captcha If you are human, leave this field blank.
