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Governor's Point of Light Award

Read the criteria for the Governor's Points of Light Award

Printable version of the nomination form PDF Format

You must have an email account set up in Outlook or Netscape Communicator or a similar program to use this form. If you do not use one of these programs or a similar one please email all this information to sanobijohnson@utah.gov. We apologize for the inconvenience.

 Questions:
Contact the Utah Commission on Volunteers at 1-888-755-UTAH(8824)

Problems:
If you are having problems submitting this form please email sanobijohnson@utah.gov and explain the problem so it can be corrected. You may also submit a nomination by sending the completed form to sanobijohnson@utah.gov.

Nominee

Nominee's Name
Please verify spelling
Telephone Number
( ) -
Address of Nominee
City
State
Postal Code
Date of Birth
/ /
Length of Time Service Peformed
Was the nominee compensated for his/her service?
Yes    No

References

Must be persons familiar with the nominee's service. A reference is deemed insufficient if it is from a member of the nominee's immediate family.
Reference #1
Full Name
Daytime Telephone Number
 ( ) -
Reference #2
Full Name
Daytime Telephone Number
 ( ) -

Narrative

All nomination forms must be accompanied by a narrative statement that describes the nominee's community service activities and also demonstrates how those activities address the community's serious social problems. Narratives should be no more than 500 words. Nominations submitted without a narrative will not be considered.

Supplementary materials (letters, testimonials, news clippings, etc.) are strongly encouraged, and should be sent to:

Governor's Points of Light Award
324 South State Street Suite 500
Salt Lake City, UT 84111

Nominator

By submitting this form, I hereby acknowledge that the information contained in this nomination is an accurate representation of the service performed by the nominee. All information is confidential.

Nominator's Name
Title
Daytime Telephone Number
( ) -

324 South State Street, Suite 500 | Salt Lake City, Utah 84111 | Phone: 1-801-538-8700 | Toll Free: 1-888-755-UTAH (8824) | Fax: 1-801-538-8690