Form 1.2 - Community Service Certificate Nomination Webform

Program Purpose - To formally recognize and award individuals or groups who, by their personal actions, volunteer efforts, and civic or community activities have made a positive impact in Fluvanna County.

Section 1 - Individual(s) or Group Being Nominated
Please tell us about the Individual(s) or Group that you would like to nominate for a Community Service Award.
Date of Action
Section 2 - Description of Acts/Service
(Acts or services being recognized must have been performed in Fluvanna County.)
Recognition Categories (check all that apply):
Please provide detailed factual information about the act of service, including why the nominee's efforts stand out and how the nominee's efforts exemplified the recognition category(ies) selected. Please attach additional sheets or supporting documentation, as needed.
Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx.
Section 3 - Person Making the Nomination
Your relationship to nominee(s)?
Date of Submission
Yes, this is a trick question and easy to answer.
We ask it because spam bots are not smart enough to answer correctly, while humans are.
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