SAS Nomination Form

NOMINATION FORM

We are seeking nominees who exemplify Rotary's motto, “Service Above Self,” by living “Rotary's 4-Way Test” every day. Click here for the Service Above Self award Program Guidelines.

Of the things we think, say, or do -
Is it the Truth?
Is it Fair to All Concerned?
Will it Build Goodwill and Better Friendships?
Will it be Beneficial to All Concerned?

Please complete and submit this form to nominate a student for the Trumansburg Rotary Service Above Self awards program.

* Indicates required field

Student's Name *

First

Last

Student's Year in School *

Student's Email *

Student's Phone Number *

Student's Address *

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City

State

Zip Code

Country

The student I have nominated exemplifies Rotary's Motto and Four-Way Test in their daily lives, identified in the five criteria listed below -

1. Service Above Self: Student exemplifies Service Above Self. Student demonstrates commitment to selfless volunteer service.

2. Truthful: Student is truthful. Student demonstrates honesty, high ethical standards, trustworthiness, integrity, self-discipline, and responsibility. Student arrives on time, comes prepared, completes tasks/assignments, and follows rules and regulations.

3. Fair to all Concerned: Student is fair to all concerned. Student demonstrates ability to work with and motivate others, has sound values, good judgment, a sense of fairness, and has earned the respect of their peers. Student handles success and defeat with maturity and a positive attitude.

4. Goodwill and Better Friendships: Student builds goodwill and better friendships. Student is courteous, helpful, and compassionate towards others. Student's positive attitude is reflected in the climate and culture of their endeavors.

5. Beneficial to All: Student's efforts and endeavors are beneficial to all. Student takes the initiative, readily and unselfishly helping others. Student is diligent, actively participates, and continually strives to the limits of their abilities. Student is committed to making a difference in the school and/or community.

Why did you nominate this student?

Please describe why you nominated this student. Include your knowledge of the student’s service, a particular event, encounter, etc. We encourage you to include quotes from other acquaintances of the student supporting this nomination. *

Nominator's Information
Please note, you may choose to use either your business/employee or personal contact information.

Nominated By: *

First

Last

Relationship to Nominee *

Email *

Phone Number *

Address *

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Line 2

City

State

Zip Code

Country

You should receive the response "Thank you. Your information has been submitted." after clicking "Submit," below. Rotary will send you an email confirmation upon receipt of your submission. If you do not receive an email confirmation, please contact Trumansburg Rotary here.

By submitting this form, I acknowledge that the information is accurate to the best of my knowledge.

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Trumansburg Rotary​Service Above Self Award

Trumansburg Rotary
Service Above Self Award