2021 Veteran and Servicemember Awards - Nomination Form

vsma nomantions

In recognition of the extraordinary volunteerism of our military Servicemembers and Veterans, we are calling for nominations to spotlight the efforts of our military community in the 76th Assembly District.

Please fill out this form if you would like to submit a nomination for a military Servicemember or Veteran who in 2021 has positively impacted the communities and neighborhoods in the 76th Assembly District.

Nominee's Name
Nominee's Residential Address:
If nominee is not a resident of the 76th Assembly district, but works or is involved in the district:
Nominee's Work Address:


Please provide a brief (600 words or less) description of your nominee’s achievements, contributions to the community, or volunteer efforts demonstrating why they are deserving of this recognition. In your response, please emphasize how they have created a positive impact for residents of the 76th Assembly District through volunteerism and service to their neighbors.

You may also attach articles, press releases, newsletters or web links in support. Acceptable documents include Word docs, PDF, RTF, TXT, and HTML. Maximum of 3 uploads.
Maximum 3 files.
200 MB limit.
Allowed types: txt, rtf, html, pdf, doc, docx, .