2025 Governor's Volunteer Service Award Nomination Form

The Governor's Volunteer Service Award (GVSA) honors the true spirit of volunteerism by
recognizing individuals who significantly contribute to their community through volunteer
service.

The Commission reviews county recommendations and awards are given out in
the counties. The guidelines and application form are provided below.

1. Nominees must have been engaged in volunteer activities for at least one year in North Carolina. Volunteer service performed outside the state is ineligible.

2. Nominees are ineligible if they receive compensation for their service.

a.This includes service done for school credit, in the official capacity of National Service programs, as a “loaned executive”, or for other forms of compensation.

3. Nominees are ineligible if they are required to do the service.

a.This includes services mandated by schools, the court, or other authorities.

4. Self-nominations are ineligible.

5. Previous award recipients from within the past 10 years are ineligible.

6. Family members may not nominate their family members.

7. Group Nominees must be made by someone external to the group.

Important Submission Requirements

1. All nominations must be submitted on this nomination form or on the link on our website (nc.gov/volunteer).
2. All required parts of the nomination form must be completed.
3. All nominations must be typed. Email your county award coordinator for a copy of the nomination form in Word.
4. The nomination form must be signed and dated by the nominator.
5. Additional information and/or supporting documents will not be accepted.
6. Nominations must be submitted by the deadline.
7. One additional reference is required for each nomination.

Award Selection

Award selections are based on the nominee’s volunteer efforts and commitment of time, accomplishments, community impact, and enhancement of the lives of others. Nominations are evaluated by the appropriate County Award Coordinator who submits up to ten nominations to the Commission for consideration. Of the submitted, one may be recommended (at the discretion of the County Award Coordinator) for the Medallion Award, the highest level of volunteer recognition in the state. Please note if a group is awarded the Medallion, only one physical medallion is given and extra medallions are not available for purchase.

The Commission selects award recipients based on merit and eligibility and without regard to race, ethnicity, religion, gender, national origin, or physical/mental disability.

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1. Nominee (First and Last or Group Name)

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2. Title:

Dr.

Rev.

Hon.

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3. Home Address

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4. Phone Number

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5. Email Address

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6. If your nominee is a youth or senior volunteer, please check the appropriate box below:

Youth: A volunteer who is 19 or younger.

Senior: A volunteer who is 55 or older.

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7.
Special Volunteer Type: (Required)

Individual: one person providing outstanding volunteer service.

Group: two or more individuals who volunteer together as a team.

National Service Member: Anyone who volunteers with a National Service program (AmeriCorps, VISTA, Senior Corps).

Director of Volunteers (Paid staff): A paid staff member who exceeds expectations of good volunteer management skills including recruitment, training, coordination, risk management, evaluation, retention, and recognition of volunteers. Other job titles may include Volunteer Program Director of Manager of Volunteers

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8.
Area of Volunteer Service: (Mark all that apply. Minimum 1 response req.)

Veteran/Military: Notable service to military families or veterans.

Youth Service: Extraordinary commitment to mentoring or educating youth.

Seniors: Significant devotion to assisting older adults.

Historically Underserved Populations: Noteworthy dedication to assisting marginalized populations.

Disaster: Remarkable volunteerism in disaster preparedness, response, recovery, or mitigation activities.

Animals: Outstanding dedication to volunteering with or for animals.

Cultural: Remarkable devotion to restoring or preserving history, culture, or the arts.

Environment: Exceptional commitment to environmental stewardship.

Health & Human Services: Significant dedication to those in need.

Lifetime Achievement: An individual who has exhibited a lifelong commitment to volunteerism and community service. Nominees must have made a substantial and long-term sustained impact in the community because of their service efforts.

Other: If your area of volunteer service is not listed above.

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9.
Nominator Information

Name (will act as online signature) *

Relationship to Nominee (i.e. volunteer supervisor)

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number *

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10. Please select your prefered method of contact

Phone

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11.
Service Details (for the past year only):
For the below, provide an estimate. For group nominations, provide a combined estimate.

Organization (s) where the nominee volunteers:

Primary County of Service:

Number of Hours Volunteered Per Week:

Number of Weeks Volunteered Per Month:

Number of Hours Volunteered Annually:

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12. Please explain the main reasons this nominee is being nominated. Describe the nominee’s outstanding commitment to volunteerism and the agency or organization they served. Mention outstanding accomplishments and how the impact of their service has helped meet critical needs in their community. Describe the nominee’s special skills, qualities, and/or leadership in at least 150 words.

Focus on service for the past year only – except for lifetime achievement nominees.

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13. References
IMPORTANT REQUIREMENTS FOR THIS PAGE

One additional reference is required.
For the nomination to be accepted, the nominator and at least one reference must be completed with name, relationship, phone, and email.
The nominator may not serve as the only reference.

References #1 (Required)

References #2

References #3

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14. Group Nominee Names *This should be completed only for Group/Team Volunteering nominees.

Group Nominee name #1

Group Nominee name #2

Group Nominee name #3

Group Nominee name #4

Group Nominee name #5

Group Nominee name #6

Group Nominee name #7

Group Nominee name #8

Group Nominee name #9

Group Nominee name #10

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15. ATTESTATION*

I attest that this nominee is an outstanding volunteer with good character and worthy of this award. I am not related to nor part of the nominee group.

DON'T FORGET TO CLICK SUBMIT !

2025 Governor's Volunteer Service Award Nomination Form

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1. Nominee (First and Last or Group Name)

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2. Title:

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3. Home Address

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4. Phone Number

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5. Email Address

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6. If your nominee is a youth or senior volunteer, please check the appropriate box below:

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7. Special Volunteer Type: (Required)

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8. Area of Volunteer Service: (Mark all that apply. Minimum 1 response req.)

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9. Nominator Information

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10. Please select your prefered method of contact

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11. Service Details (for the past year only):For the below, provide an estimate. For group nominations, provide a combined estimate.

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13. ReferencesIMPORTANT REQUIREMENTS FOR THIS PAGE One additional reference is required. For the nomination to be accepted, the nominator and at least one reference must be completed with name, relationship, phone, and email.The nominator may not serve as the only reference.

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14. Group Nominee Names *This should be completed only for Group/Team Volunteering nominees.

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15. ATTESTATION*

7.
Special Volunteer Type: (Required)

8.
Area of Volunteer Service: (Mark all that apply. Minimum 1 response req.)

9.
Nominator Information

11.
Service Details (for the past year only):
For the below, provide an estimate. For group nominations, provide a combined estimate.

13. References
IMPORTANT REQUIREMENTS FOR THIS PAGE

One additional reference is required.
For the nomination to be accepted, the nominator and at least one reference must be completed with name, relationship, phone, and email.
The nominator may not serve as the only reference.