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Get Rotary Service Above Self Award Nomination Form

SERVICE ABOVE SELF AWARD NOMINATION FORM EN 616 Rotary s highest honor recognizes Rotarians who demonstrate Rotary s motto Service Above Self by volunteering their time and talents to help others. CRITERIA To deserve consideration for the Service Above Self Award a Rotarian must have performed continuing humanitarian service in any form. This award is intended to recognize especially those who actively help others through Rotary. Please indicate your role Current district governor Current RI director Immediate past district governor Past RI director Address City State/Province Postal code Phone number Email Signature Date Service Above Self Award Nomination Form Page 1 QUALIFICATIONS General biography Rotary service activities including Rotary positions held Non-Rotary service activities Describe how this candidate embodies Service Above Self. Page 2. The award is internationally competitive and is granted to no more than 150 Rotarians worldwide and no more than one from each district each year. HOW TO NOMINATE A CANDIDATE Only district governors immediate past district governors RI directors and past RI directors may honor exemplary Rotarians by nominating them to be considered for this award. Nominate as many as three people by completing this form for each. Type the information asked for below in the space that is provided* Do not attach any supporting materials or additional sheets. Instead make the case that your nominee deserves this award in your responses to the long-answer questions. Submit the nomination to Rotary International World Headquarters no later than the close of business 1 October by emailing it to riawards rotary. org or mailing it to Service Support and Awards PD210 Rotary International One Rotary Center 1560 Sherman Avenue Evanston IL 60201-3698 USA RI will notify the governor of the district of each Rotarian who is nominated in accordance with RI Board policy. It is not awarded solely in recognition of one s performance in an elected or appointed Rotary assignment and financial contributions to The Rotary Foundation or specific projects will not be considered* ELIGIBILITY You may not nominate yourself for this award. You may not nominate your spouse child grandchild the spouse of a child or grandchild or a parent or grandparent. No Rotarian may receive the award posthumously or more than once. Any active Rotarian in good standing may be nominated except the following District governors governors-elect or immediate past district governors RI presidents presidents-elect or past presidents RI directors directors-elect or past directors Rotary Foundation trustees incoming trustees or past trustees NOMINEE Use a separate form for each nominee. Last name First name Classification or former classification Rotary club District Country Member ID Number of years of Rotary membership NOMINATOR To nominate someone for this award you must be one of the following. The award is internationally competitive and is granted to no more than 150 Rotarians worldwide and no more than one from each district each year. HOW TO NOMINATE A CANDIDATE Only district governors immediate past district governors RI directors and past RI directors may honor exemplary Rotarians by nominating them to be considered for this award. .

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