Paul Harris Recognition Nomination Form

Purpose of the Recognition:

To honour an individual (Rotarian or a Non-Rotarian) who has consistently demonstrated support for the objectives of Rotary and who satisfies the spirit and intent of the Recognition. The Club recognizes honourees with a Paul Harris Fellowship.

The certificate states that the recipient has been named a Paul Harris Fellow: "In appreciation of tangible and significant assistance given for the furtherance of better understanding and friendly relations between the peoples of the world."

Important note to the nominator: To ensure the Recognition Committee fairly considers all nominations, the information needs to be consistent.

Please Note that:

1. Incomplete forms may not be considered due to lack of information.

2. Please provide a detailed summary of the nominee's credentials.

Nominated by:

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Nominee's Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

A. Please itemize the nominee's contribution to Rotary or community:

Note: the contribution is not necessarily in the works of charity. For example, contributions can be in the advancement of arts, education, health, community development/improvement or other significant contributions.

B. What is (was) the impact of the candidate's work on the Rotary or community?

Note: By impact, we mean how the nominee's contribution helped Rotary or community.

C. Is there anything else you would like to share about your nominee that you believe the Selection Committee should be aware?

YesNoUnknown

Please do not tell the candidate that they are nominated for this recognition. Please submt this form before the due date which is 5:00 pm on the last business day of February each year. Recognitions are normally awarded in the Spring of each year. You will be notified if your nominee is selected.

Please verify that you are human*

Nomination Form for a Paul Harris Fellowship Recognition