Senior Service Award Nominations – Office of Missouri Lieutenant Governor

Qualifications

Nominees should be Missourians who are at least 60 years of age and volunteer a minimum of 25 hours per year. Nominations are open from February 14 to March 20, 2023. If you have any issues with the form, please contact Gabby Picard: Gabrielle.Picard@ltgov.mo.gov or 573-751-1088.

Senior Service Award Nominee Information

Nominee Name *

First

Last

Nominee Address *

Address Line 1

Address Line 2

City

State

Zip Code

Nominee Phone *

Nominee Email

Volunteer Organizations *

Is this senior a veteran? *

Yes
No
Unsure

Date of Birth *

Summary *

Write a summary 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.

Senior Service Award Nominator Information

Nominator Name *

First

Last

Nominator Organization *

Nominator Address *

Address Line 1

Address Line 2

City

State

Zip Code

Nominator Phone *

Nominator Email *

Send Gabby Picard, Gabrielle.Picard@ltgov.mo.gov any additional attachments

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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