2024 DSA Nomination Form

2024 Distinguished Service Awards Nomination Form

Nomination Deadline: January 17th, 2023. Awards to be presented March 9th, 2024.
INSTRUCTIONS

Please only use this form to nominate one person or company at a time. If you would like to nominate more than one person or company, please use this form again separately.

One person may not nominate more than one person/business per category. (Example: You may nominate someone for a Junior First Citizen Award and someone for a Distinguished Service Award, but not two people for a Junior First Citizen Award.)

Each nomination MUST come with at least TWO letters of recommendation. If you have letters from other people to accompany this nomination that will be submitted separately, please let us know. Please also indicate if you will be physically dropping off or mailing us your Letters of Recomendation.

Physical address: 435 W. 1st. Ave, Albany, OR 97321

If mailing, please address to: Albany Area Chamber of Commerce, DSA Selction Committee, PO Box 548, Albany, OR 97321

If you need assistance: Please email Janet at jsteele@albanychamber.com, Jorden at jparrish@albanychamber.com, or call the Chamber office at 541-926-1517.

Nominate Someone for a Distinguished Service Award
Distinguished Service Awards

Distinguished Service Award (Outstanding career of community service. Age 55+)

Jim Linhart First Citizen Award (Outstanding service during the last 3 years. Aged between 40-55)

Junior First Citizen Award (Outstanding service during the last 3 years. Under age 40)

Finalists and recipients will be honored based on the following criteria:

Individuals participate actively on service projects and programs leading to civic improvement, human welfare, and/or environmental enhancement. The nominee must also have a positive impact on the social or economic climate of the community, and influence the community through their leadership.
Which DSA Award?

Distinguished Service AwardJim Linhart First Citizen AwardJunior First Citizen Award
Nominee's Name

First NameLast Name
Nominee's E-mail Address
Nominee's Phone Number
Please enter a valid phone number.
Nominee's Occupation/Title
Nominee's Spouse's Name
Nominee's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Nominate for a Chamber Business of the Year Award
Chamber Business of the Year Awards

Large Business= 25+ employees, Small Business= less than 25 employees.

Includes Albany Area Chamber member businesses, organizations, and non-profits. They may nominate themselves.

Finalists and recipients will be honored based on the following criteria:

Businesses have made a substantial contribution to the community for the last five years or longer. Business Excellence - Achieved successful business practices, e.g. marketing, promotional activities, strong ethics. Promotes employee self-growth and development. Has demonstrated a high level of customer satisfaction, confidence, and service. Community Service - Has proven their interest in the welfare of the community through financial contributions, personal service or civic leadership.
Which Business of the Year Award?

Large Chamber Business of the YearSmall Chamber Business of the Year
Business Name
Name of Owner/CEO
Date Established
Number of Employees
Business or CEO Email
example@example.com
Business Phone Number
Please enter a valid phone number.
Address of Business

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Information
Nomination Submitted By:

Please include your contact information so we may reach out to you if needed.
Your Name*

First NameLast Name
Your E-mail Address*
Your Phone Number*
Please enter a valid phone number.
Business*
Your workplace

Winners will be Selected Based on the Following Criteria:

This information is separate from the letters of recommendation. You may provide this information as a separate document if you prefer.
1. Civic & Community Involvement - Active participation in service projects and programs leading to civic improvement, human welfare or environmental enhancement. May include service as an elected/appointed public official with related achievement during the service period.
2. Social & Economic Impact - How has the nominee had an overall positive impact on the social/economic climate of the community?
3. Leadership - How has the nominee’s leadership influenced the community?
4. Overall Community Service - Why should this individual or business be nominated for the Distinguished Service Award?
(optional) Upload your explanation of this criteria here

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Letters of Recommendation

Minimum of two letters of recommendation must accompany each nomination. If you would like to physically mail or bring in your letters of recommendation, please indicate you will be doing so.
How will you be submitting your Letters of Recommendation?*

File upload (below)I will be dropping them off in personI will be mailing them inOther
Will other people be submitting separate letters of recommendation as part of your nomination?

YesNoOther
Please explain who else will be contributing letters of recommendation for your nomination, and how they will be submitting them.
Please upload at least two (2) letters of recommendation to accompany each nomination.

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2024 Distinguished Service Awards Nomination Form