Vliet Award Nominations

Elmer Vliet Community Service Award Nomination Form
In the spirit of “community above self” which Elmer Vliet embodied, the Village Board has established the the Elmer Vliet Community Service Award to recognize volunteers who complete noteworthy community service as nominated by members of the Lake Bluff community. Recipients may receive the award for, among other reasons, the completion of meritorious acts and initiatives or for a history of meritorious service to the community.

Use this form to submit an nomination of a community member or organization prior to 11:59 p.m. on Friday, August 1, 2022.

More information about the award process:
1. Nominations will be submitted to a committee comprised of the Village President and two volunteers chosen by the President. All committee members shall be committed to the award selection process and its relevance to sustaining civic participation.
2. Award winners will be notified in advance of the presentation ceremony.
3. The Village President may present the awards to the recipients during the Annual Volunteer Recognition Event (typically held in September) or at times and locations that may better serve the purposes of this award program.

Contact Information for Person Filing Nomination
Name *

First Name Last Name or Organization (if applicable)
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Nominated Person or Organization
Name *

First Name Last Name or Organization (if applicable)
Address

Street Address

Street Address Line 2
Email
example@example.com
Phone Number
Please enter a valid phone number.
No Affiliation *

I understand that the nominee is not myself; a member of my household; or an organization I am currently affiliated with. (If you cannot answer "yes" to this question, you cannot submit this nomination.)

Statement of Merit
In a brief statement (less than 250 words), how has this individual or organization had a significant, positive impact on the Lake Bluff community? *
Award Criteria

The Vliet Award Committee considers these four criteria. A nominee need not excel in every criteria to receive the award. You may optionally provide a statement that describes how the nominee exemplifies each criteria.
IMPACT ON THE COMMUNITY - The effects of the service efforts and/or project on the community.
COMMITMENT TO PUBLIC SERVICE - Examples of enthusiasm, perseverance, and devotion to a short-term or long-term project.
INTEGRITY - Past or current actions that reflect the nominee’s honesty, reliability, and sincerity.
LEADERSHIP – Examples of leadership qualities that helped create momentum, a shared vision, and positive results.
Should be Empty:

Elmer Vliet Community Service Award Nomination Form