Criteria Checklist:

  • An agent can nominate him or herself or they can be nominated by someone else.
  • The agent must have at least two full years of service, be in good standing and actively writing business with the National Life Group. (Career agents must have full-time status)
  • Nominees have been supporting their cause for at least one year.
  • The agent’s time and effort to their cause is making a difference and positively impacting their community and the lives of others. 
  • Their cause is a 501(c)(3) non-profit organization that is not a religious, labor or fraternal group.
  • The organization must not discriminate in any way on the basis of race, religion, gender, age, national origin, disability or sexual orientation.
  • An agent can only win once in a five-year period.
  • Agent causes can be domestic or international.
Please fill out the following information:

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* 1. Agent's First Name:

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* 2. Agent's Last Name:

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* 3. Agent's Email:

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* 4. Agent's Telephone Number:

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* 5. Agency Address:

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* 6. What is the Agent's Cause? (For example, animal welfare, hunger, autism awareness, etc..)

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* 7. How Does the Agent Support the Cause Other Than Making Monetary Donations? Please provide as much detail as possible.

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* 8. What Nonprofit Organization Does the Agent Work with to Impact This Cause? (If selected, this is the organization what will receive the award. It must also be a 501(c)(3) non-profit organization that is not a religious, labor or fraternal group and must not discriminate in any way on the basis of race, religion, gender, age, national origin, disability or sexual orientation.)

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* 9. Your Name:

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* 10. Your Email:




National Life Group® is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest, Addison, TX and their affiliates. Each company of National Life Group is solely responsible for its own financial condition and contractual obligations. Life Insurance Company of the Southwest is not an authorized insurer in New York and does not conduct insurance business in New York.

TC110970(1019)1                               For Agent Use Only - Not For Use With the Public

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