Senior Service Award Nominations – Office of Missouri Lieutenant Governor

Qualifications

Individuals should be at least 60 years of age and volunteer a minimum of 25 hours per year. Nominations are due March 14, 2022. If you have any issues with the form, please contact Halie Dampf: halie.dampf@ltgov.mo.gov or 573-751-1088.

NOMINEE INFORMATION

Nominee Name *

First

Last

Nominee Address *

Address Line 1

Address Line 2

City

State

Zip Code

Nominee Phone *

Nominee Email

Volunteer Organizations *

Date of Birth *

SPONSOR INFORMATION

Sponsor Name *

First

Last

Sponsor Organization *

Sponsor Address *

Address Line 1

Address Line 2

City

State

Zip Code

Sponsor Phone *

Sponsor Email *

Write-Up

Click or drag files to this area to upload. You can upload up to 2 files.

Please upload a write-up of the nominee's volunteerism and community involvement. Be sure to include information that illustrates a difference the nominee has made and how their efforts have favorable impacted their fellow citizens, organizations and/or the community in general.

Office of Missouri Lieutenant Governor

State Capitol Building - Room 224
Jefferson City, MO 65101
Phone: 573.751.4727
ltgovinfo@ltgov.mo.gov

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