Service Above Self Award PDF Details

The Service Above Self Award Form is a document that recognizes individuals for their exceptional service to others. This form can be used to nominate someone for an award, or to recommend someone for recognition. The dedicated service of recipients is often in the form of time, effort, and personal sacrifice. Thank you letters may also be included with the nomination. This form is designed to provide concise and specific information about the individual being nominated, as well as their outstanding service. Any individual, group, or organization can submit a nomination. Please complete all sections of this form and return it to your local district office. Your district will review all submissions and choose the recipient(s) at the next level of governance.

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QuestionAnswer
Form NameService Above Self Award
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnomination for quality award example, self nomination for award sample, rotary service above self award, self award nomination sample

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SERVICE ABOVE SELF AWARD NOMINATION FORM

EN—(616)

Rotary’s highest honor recognizes Rotarians who demonstrate Rotary’s motto, Service Above Self, by volunteering their time and talents to help others. The award is internationally competitive and is granted to no more than 150 Rotarians worldwide, and no more than one from each district, each year.

HOW TO NOMINATE A CANDIDATE

Only district governors, immediate past district governors, RI directors, and past RI directors may honor exemplary Rotarians by nominating them to be considered for this award. Nominate as many as three people by completing this form for each. Type the information asked for below in the space that is provided. Do not attach any supporting materials or additional sheets. Instead, make the case that your nominee deserves this award in your responses to the long-answer questions.

Submit the nomination to Rotary International World Headquarters no later than the close of business

1 OCTOBER by emailing it to riawards@rotary.org or mailing it to:

Service Support and Awards (PD210)

Rotary International

One Rotary Center

1560 Sherman Avenue

Evanston, IL 60201-3698 USA

RI will notify the governor of the district of each Rotarian who is nominated, in accordance with RI Board policy.

CRITERIA

To deserve consideration for the Service Above Self Award, a Rotarian must have performed continuing humanitarian service in any form. This award is intended to recognize especially those who actively help others through Rotary. It is not awarded solely in recognition of one’s performance in an elected or appointed Rotary assignment, and inancial contributions to The Rotary Foundation or speciic projects will not be considered.

ELIGIBILITY

You may not nominate yourself for this award. You may not nominate your spouse, child, grandchild, the spouse of a child or grandchild, or a parent or grandparent. No Rotarian may receive the award posthumously or more than once. Any active Rotarian in good standing may be nominated, except the following:

District governors, governors-elect, or immediate past district governors

RI presidents, presidents-elect, or past presidents

RI directors, directors-elect, or past directors

Rotary Foundation trustees, incoming trustees, or past trustees

NOMINEE

Use a separate form for each nominee.

Last name

 

First name

 

Classiication or former classiication

Rotary club

 

 

 

 

 

 

 

 

District

 

Country

 

Member ID

Number of years of Rotary membership

NOMINATOR

To nominate someone for this award, you must be one of the following. Please indicate your role:

Current district governor Current RI director

Immediate past district governor Past RI director

 

 

 

 

 

 

 

 

Last name

 

First name

 

 

Rotary club

District

 

 

 

 

 

 

 

 

Address

 

City

 

 

State/Province

Postal code

 

 

 

 

 

 

 

 

Phone number

 

Member ID

 

 

Email

 

 

 

 

 

 

 

 

 

 

Signature

 

Date

 

 

 

 

 

Service Above Self Award Nomination Form

Page 1

QUALIFICATIONS

General biography:

Rotary service activities, including Rotary positions held:

Non-Rotary service activities:

Describe how this candidate embodies Service Above Self.

Service Above Self Award Nomination Form

Page 2

Watch Service Above Self Award Video Instruction

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