Community Service Award Nomination Form

2. MT. LEBANON COMMUNITY RELATIONS BOARD WILL PRESENT COMMUNITY SERVICE AWARD

4. Hundreds of Mt. Lebanon residents volunteer their time each year, giving back to the community in ways that make a real difference in the quality of life here and throughout our region. Each year, the Mt. Lebanon Community Relations Board spotlights a resident who represents the community’s strong volunteer spirit by presenting him or her with the Mt. Lebanon Community Service Award.
   Residents are invited to submit nominations for the 2021 award, which will honor a resident “whose volunteer efforts demonstrate creativity, vision, leadership and citizenship by providing service to programs and activities that positively impact the welfare of the Mt. Lebanon community.” The Community Relations Board will present the award in cooperation with Mt. Lebanon Magazine.

   Residents are invited to submit nominations for the 2021 award, which will honor a resident “whose volunteer efforts demonstrate creativity, vision, leadership and citizenship by providing service to programs and activities that positively impact the welfare of the Mt. Lebanon community.” The Community Relations Board will present the award in cooperation with Mt. Lebanon Magazine.

6. This year’s winner will be selected by a Community Relations Board subcommittee and approved by the entire board. The winner will be honored at a commission meeting this spring and at the 2022 Boards and Authorities dinner.
   One nomination is enough for a volunteer to be considered. Multiple applications will not increase a nominee’s chance of winning. Mt. Lebanon elected officials, municipal staff members and current members of the Community Relations Board are not eligible to participate. Deadline for nominations is Friday, March 12.

   One nomination is enough for a volunteer to be considered. Multiple applications will not increase a nominee’s chance of winning. Mt. Lebanon elected officials, municipal staff members and current members of the Community Relations Board are not eligible to participate. Deadline for nominations is Friday, March 12.

8. The selection criteria for Mt. Lebanon Community Service Award are:

10. • makes a significant contribution to the community in a volunteer service capacity

    • makes a significant contribution to the community in a volunteer service capacity

11. • participates in humanitarian activities that make a difference in the well-being of others

    • participates in humanitarian activities that make a difference in the well-being of others

13. • has exceptional ethical qualities and strives to improve and preserve the community

    • has exceptional ethical qualities and strives to improve and preserve the community

14. • is an inspirational role model for the Mt. Lebanon community.

    • is an inspirational role model for the Mt. Lebanon community.

18. Name of Outstanding Volunteer

20. Volunteer's Address

22. Volunteer's Daytime Phone/Email

24. Volunteer's Significant Community Contributions

    (Please provide no more than 750 words and any supporting documentation such as a resume, newspaper articles, programs)

26. Supporting Documentation

30. Nominator's Name

32. Nominator's Address

34. City

35. State

36. Zip

38. Nominator's Daytime Phone/Email Address:

40. Name and phone/email of someone (preferably from a nonprofit organization or agency) who can verify volunteer's contributions

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42. Submit Submit and Print

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