Clone of 2025 DSA Nomination Form

2026 Distinguished Service Awards Non-Profit Nomination Form

Nomination Deadline: January 16th, 2026. Awards to be presented March 14th, 2026.
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 Jadyn at jbaskin@albanychamber.com, or call the Chamber office at 541-926-1517.

Nominate for a Chamber Business of the Year Award
Non-Profit OF THE YEAR AWARDS

Albany Area Chamber Member Non-Profits 501 (c) 3 are included in this category and may nominate themselves.

Eligibility

Must be a registered 501(c)(3) nonprofit organization.
Organization should be headquartered in or primarily serving the Albany Area.
Demonstrated impact, innovation, and alignment with community and Chamber values.

Nomination Packet Must Include

Completed Nomination Form (included in this packet).
Responses to all five narrative questions.
At least one letter of support.
At least one community reference.
Optional: Additional documentation (impact reports, news articles, testimonials).

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

Organizations 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.
Non-Profit Name
Name of President/CEO
Date Established
Number of Employees
Number of Volunteer Hours
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. Community Impact: Demonstrates measurable outcomes that improve quality of life in the region. Addresses a significant local need with both short-term results and long-term impact.
2. Leadership & Innovation: Employs creative or strategic approaches to solving community challenges. Demonstrates resilience and invests in leadership development.
3. Collaboration & Partnership: Builds effective partnerships with nonprofits, businesses, schools, or civic organizations. Promotes shared goals and demonstrates cross-sector collaboration. Models collaboration between nonprofits and the business sector.
4. Stewardship & Transparency: Operates with strong governance, fiscal responsibility, and accountability. Utilizes diverse and sustainable funding sources; communicates results openly. Supports economic vitality, workforce development, or community enrichment.
5. Community Engagement & Volunteerism: Inspires volunteer participation and incorporates stakeholder voices. Maintains strong relationships with community members.
(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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2026 Distinguished Service Awards Non-Profit Nomination Form

Nomination Submitted By:

Winners will be Selected Based on the Following Criteria:

Letters of Recommendation