Chesapeake First Citizen Nomination Form

“Service Above Self”

NOMINATION FORM – 2023 FIRST CITIZEN AWARD OF CHESAPEAKE

Deadline for submission: March 31, 2023

Purpose:

The Chesapeake First Citizen Award is presented annually to an outstanding individual who best exemplifies the spirit of citizenship and who has shown significant leadership through his/her time, talents, and efforts to enhance the quality of life in the City of Chesapeake.

Eligibility:

-Nominee should have been a legal resident of Chesapeake, Virginia during the nominee’s key years of service. Current residence not mandatory; though highly preferred.
-Nominee’s service to the City of Chesapeake should reflect interest in areas other than his/her professional work.
-Nominee’s accomplishments should have made a positive impact on the quality of life in the City of Chesapeake and its place in the Hampton Roads region.

Selection Criteria:

The judges are a committee comprised of former First Citizens of Chesapeake. The committee will meet and select from nominations submitted to the First Citizen Committee chairman. The committee will consider the nominee’s adherence to the Rotary motto “Service Above Self” as they review a nominee’s service record. The First Citizen Award recognition is a celebration of volunteerism and the extra effort that is made outside of one’s profession to make Chesapeake and the Hampton Roads region a better place to live.

Awards Ceremony:

The 2023 First Citizen Award recipient will be honored at the First Citizen Award banquet to be held at the Chesapeake Conference Center on Thursday, September 14, 2023. Persons nominating deserving citizens need to affirm that the nominee, if selected, can attend on that date as this is a mandatory criteria for selection.

Endorsements:

Letters of endorsement are permissible. Such letters should state why the person believes the nominee deserves to become the First Citizen of Chesapeake.

Nomination Process:

Nomination submissions with attachments may be submitted online using the form below. Additional information and documents that cannot be attached here may be mailed to the First Citizen Award Committee c/o Chesapeake Rotary Foundation, Post Office Box 15705, Chesapeake, VA 23328 no later than March 31, 2023.

Nominee Full Name*

Prefix First Name Middle Name Last Name Suffix

Describe the background of the nominee and the scope of his/her work or activity in the community.

Describe the nominee's exceptional achievement and contribution in their organization, community, state, or nation.

List statements of support for this nomination from authorities, including honors and awards received which exemplify their achievements and contributions.

A nominee may excel in many areas:

Service to humanity
Personal improvement
Financial success and economic innovation
Social improvements to major contemporary problems
Voluntary service or philanthropic contribution
Politics or governmental service
Scientific or technological contributions
Legal reform
Cultural achievements (include contributions in literature, history, education or the arts)
Academic Leadership and Accomplishment
Moral and religious leadership
Success in the influence of public opinion (news media or other means)
Any other important contributions to community, state, or nation

Describe how the nominee excels in at least three of the above areas

Describe why you believe that your nominee should be selected as the First Citizen of Chesapeake

Nominee Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Nominee E-mail

example@example.com

Nominee Phone Number*

Nominee Occupation and Position or Title

Nominee Business

Nominee Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Schools attended (Degrees, Academic Honors)

Family Information is desired (Spouse, children, etc.)

Organizations and Affiliations

Include leadership positions held

Awards and Honors

Dates of residency and service to Chesapeake

Attach Letters of Recommendation, and other Supporting Documentation here

Nominator's Name

First Name Last Name

Nominator's Business

Nominator's Email

example@example.com

Nominator's Business Telephone

Please enter a valid phone number.

Nominator's Telephone

Please enter a valid phone number.

Nominator's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code