Governors Leadership Medallion Nomination Form
The Governor’s Leadership Medallion is a special recognition for Kiwanians within the Georgia District who have exemplified outstanding leadership skills by strengthening their club, division and/or the district furthering the mission of Kiwanis International. To maintain the integrity of the award, a specified number of awardees are not guaranteed. Clubs may nominate one or more members. These nominations will be sent to the District Executive Director, the Governor, and the division Lt. Governor. The Governor will decide the award winners in consultation with the Lt. Governor. Clubs will be notified of the winners and every effort should be made to have families of the winners attend the division rally when the award will be given. Please remember that this award is given only once. If the nominee has received the award previously, they are not eligible for another award. Make sure you give the nominees full name and club name. The nomination form should be signed by the club president and club secretary, unless one of them is being nominated.
Please submit this award no later than 2 weeks prior to your Division Rally!
Name of Person Submitting this Award
First Name
Last Name
Email Address of Person Submitting this Award
example@example.com
Phone Number of Person Submitting this Award
Please enter a valid phone number.
Format: (000) 000-0000.
Division #
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
15
17
18
Name of Nominee
Nominee Home Kiwanis Club
Offices and chair positions of the nominee held at the club, division, and district level.
Number of new members sponsored into Kiwanis this year
Number of new members sponsored into Kiwanis since he/she joined Kiwanis
How has the nominee had a positive impact on their community and/or the lives of children?
How has the nominee gone above and beyond other leaders in the club and why are they deserving of this special award?
Does the Club President support this nomination?
Please Select
Yes
No
Award is being given to them
If the Club President is being nominated, please list another officer that has approved this nomination.
Does the Club Secretary support this nomination
Please Select
Yes
No
This award is being given to them
If the Club Secretary is being nominated please list another officer that has approved this nomination.
By signing here you certify that the person nominated has not received the award previously.
Send Nomination
Should be Empty: