California Park & Recreation Society District 10 Awards Program Hall of Fame Nomination Career Achievement Award

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1 Career Achievement Award This award shall recognize a retiree within a member agency or organization who has made a significant contribution to District 10 and CPRS. A committee evaluates all nominees. If your nominee receives the award, you will be notified. Please provide your contact information below. Name: Agency: Phone Number: Address: Please provide the following information: *Name will be printed on award and in program. Name of individual: Last/Current position & agency: Statement of nomination in 200 words or less. Statement may be used in the awards brochure and/or read at the banquet. List previous awards received from CPRS and District 10: List other awards and/or honors received:

2 Contributions to CPRS and District 10 (e.g., board member, committee chair, or member):

3 COVETED LEADERSHIP This is the highest honor presented by CPRS District 10 to recognize a recreation professional who has provided outstanding leadership and made significant contributions and service to District 10 throughout the years; nominees must be a member of District 10. A committee evaluates all nominees. If your nominee receives the award, you will be notified. Please provide your contact information below: Name: Phone Number: Agency: Address: Please provide the following information: Name of nominee: *Name will be printed on award and in program. Title: Agency: Contributions to District 10: Contributions to related professional groups: Other qualities which make this nominee an outstanding professional: Nominee s impact on the recreation profession:

4 AGENCY/INDIVIDUAL This award shall recognize a member and/or agency for their support and contribution to District 10 and the Parks and Recreation profession. A committee evaluates all nominees. If your nominee receives the award, you will be notified. Please provide your contact information below: Name: Agency: Phone Number: Address: Please provide the following information: Special Recognition: Name of agency or individual: *Name will be printed on award and in program. How, specifically, the agency/individual has supported or contributed to the profession: Background Information: Impact of agency s/individual s support:

5 PARKS MAKE LIFE BETTER AWARD This is the highest honor presented by CPRS District 10 to recognize an outstanding District 10 facility, park, or program that has made a substantial and meaningful impact on the community and the members it serves. Please provide your information below: *Name will be printed on award and in program. Name: Phone Number: Agency: Address: Name of facility, park, or program: When was facility or park built or renovated: or When was the program established: Describe the facility/park users or program participants: Describe the facility, park, or program s meaningful impact to the community and the participants it serves:

6 Nomination Form VOLUNTEER MERIT AWARD This award is presented to individuals or organizations in recognition of their contributions to the community, profession, or member agencies. This award is non-competitive; nominees will be recognized during the banquet with a plaque commemorating their accomplishment(s). Please provide your contact information below: Name: Agency: Phone Number: Address: Please provide the following information: *Name will be printed on award and in program. Name of nominee/organization (please include phonetic spelling): Statement of not more than 200 words to be printed in the awards program: (add additional sheets as necessary) A 50-word statement to be read during the award presentation: (add additional sheets as necessary) If you require more than one plaque, please indicate quantity: x $65 = Name of person(s) or organization to appear on the additional plaque(s): Name and title of individual(s) accompanying the nominee to the stage (include phonetic spelling).

7 Nominations must be received by Friday, March 31 at noon. Remember to please to submit the following with your nomination form: A fee of $65, made payable to CPRS District 10 payable by check or Credit Card. Mail to: City of Costa Mesa, Attn: Justin Martin, 77 Fair Drive, Costa Mesa, CA

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