Service Award Nomination

Please fill out the below application to nominate an individual or group for a Competitive and/or Benchmark nomination. Nominations deadline extended to Wednesday, February 8 at 4 p.m.  

Before you begin, be sure to read over the Eligibility Guidelines.

Please note: All information must be entered in your current browser session, there is no "Save" option. It is also important to have your supporting materials (quotations, pictures) prior to starting your submission. For your convenience, please download a copy of the appropriate nomination template so you may complete each question prior to starting your submission.

  1. Benchmark Nomination Template
  2. Competitive Nomination Template

Please note: All information must be entered in your current browser session, there is no "Save" option. It is also important to have your supporting materials (quotations, pictures) prior to starting your submission.

Individuals/Groups can only be nominated for ONE competitive award. Click for descriptions of the Competitive Award Categories.

Individuals can only be nominated for ONE benchmark award. Click for descriptions of Benchmark Award Categories.
For Benchmark Awards nominator/organization can nominate up to THREE volunteers at no cost. Any additional Benchmark Award nominations will include a $35.00 fee. An invoice will be sent upon receiving completed nomination forms for additional application(s).

Individuals can be nominated for both a Competitive and a Benchmark Award.

Fields marked with an * are REQUIRED.

If you have any questions regarding the application, please contact Kristen Moore, Corporate Services & Event Coordinator, at 703-246-3531 or kmoore@volunteerfairfax.org.

* - Required field
* Award Type
Competitive Award
* Competitive Award Category
* Please give a description of the service nominee provided for the organization.
* Who or what (organization, group, or population) was directly impacted by nominee's volunteer service?
* Please provide a quote from the Executive Director and/or the Volunteer Coordinator about the nominee.
* Please provide the name of the person providing the quote
* Phonetic spelling of the name of the person providing the quote
* Title of the person providing the quote
* In your own words, please tell us why this nominee should receive this award.
Benchmark Award
* Benchmark Award Category
Nominator Information
Prefix
Mr.Mrs.Ms.MissDr.HonorableProf.SupervisorDelegateSenator
* First Name
* Last Name
Suffix
Phonetic Spelling of Nominator
* Home Address 1
Home Address 2
* Home City
* Home State
* Home Zip Code
Business Name
Job Title
Business Address 1
Business Address 2
Business City
Business State
Business Zip Code
* Set Mailing Address as
Home Address
Business Address
* Home Phone
Cell Phone
Work Phone
Work Phone ext
Fax
* Email
Nominee Information
Prefix
Mr.Mrs.Ms.MissDr.HonorableProf.SupervisorDelegateSenator
* First Name
* Last Name
Suffix
Phonetic Spelling of Nominee
Group Name
Number of Volunteers in Group or Program
Age of Volunteer
* Home Address 1
Home Address 2
* Home City
* Home State
* Nominee Home Zip Code
* Set Mailing Address as
Home AddressBusiness Address
Business Name
Business Address 1
Business Address 2
Business City
Business State
Business Zip Code
* Home Phone
Cell Phone
Work Phone
Work Phone ext
Fax
* Email
* Nominees Magisterial District
* Orgaization(s) for which nominee/group volunteered at
* Mission(s) of organization(s)
* Number of hours volunteered at organization this year
* Total hours volunteered at organization in lifetime
* Number of total years volunteered with organization
Photos
Please submit two photos of the nominee. Photos must be in high resolution (300 dpi) and a minimum of two size of 3" x 5". Photos can be vertical or horizontal in orientation and must be digitally submitted. Please indicate the first and last name of all persons in the picture, in order of appearance. (left to right)
* Photo 1
No file is currently uploaded.
Upload File
* Photo 1 Names
* Photo 2
No file is currently uploaded.
Upload File
* Photo 2 Names
* I verify that the individual/group nominated herein has performed the volunteer service as described. Judges may contact me for verification of this nomination.