F Leadership Organization Form

PRESIDENT'S VOLUNTEER SERVICE AWARD
LEADERSHIP ORGANIZATION APPLICATION FORM
Please fax completed forms to 1-202-729-8033.

ORGANIZATION'S INFORMATION
Organization's Name
Organization Leader's Name
Organization Leader's Title
Address
City
Phone
Website

State
Fax

Zip

State
Email

Zip

CONTACT PERSON'S INFORMATION
Name
Title
Address
City
Phone

TYPE OF ORGANIZATION (please check all that apply)
Business
Government
College/ University
Human Services
Community Program
Labor Union
Faith-Based
National Service Org.
Fraternity/ Sorority
Nonprofit
Other (please specify) ___________________________

School
Service Club
State Commission
Volunteer Center
Youth Development Org.

PRIMARY SERVICE AREA(s)
Youth Achievement
Includes volunteer activities such as mentoring, coaching, tutoring, improving literacy in areas such as reading and
finance, and volunteering to keep young people engaged academically in education.
Parks and Open Spaces
Includes volunteer efforts to conserve and protect our parklands and gardens, neighborhood cleanups and creating safe
playgrounds. It also includes creating safe and meaningful experiences and outdoor activities for individuals to enjoy
the environment and our natural resources.
Healthy Communities
Includes volunteer efforts to help the elderly, disabled, diseased, hungry or homeless, and to improve the economic health of
of the community. These could include volunteering for health and nutrition education services, immunization campaigns,
resume building, career training, disease screenings, hospital support, blood drives, veterans outreach, working with
local public health programs, micro-enterprise and business development.
Public Safety & Emergency Response
Includes volunteer efforts for individuals and families to make their homes, and their communities safer from the threats of
crime, terrorism, and disasters of all kinds. It includes preparedness training, volunteer firefighters, and the Citizen Corps
programs like Citizen Corps Councils, Neighborhood Watch, Medical Reserve Corps, Volunteers in Police Service and
CERT (Community Emergency Response Teams).
Global Health & Prosperity
Includes international volunteer efforts by American professionals serving abroad through non-governmental organizations
and companies to share their skills in the following areas: agriculture, capacity building, economic growth, education,
HIV/AIDS prevention and treatment, health care, information technology, natural resources, clean water, women
& youth empowerment.

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Please briefly describe your organizational structure in terms of local, state, or regional entities
(i.e., chapters, affiliates, offices, member organizations, etc.), number(s) of these entities and
total number of volunteers reached.
(Example: 50 state offices presiding over 1000 local chapters, each with 10-20 volunteers)

I am committing to distribute at least _________ President's Volunteer Service Awards in the next two years.
(Greater visibility opportunities will be available to organizations that commit to issuing at least 2,500)
I agree to actively promote the Award to my local, state, or regional chapters, affiliates, offices,
member organizations, etc.
I agree to let the President's Volunteer Service Awards program list my organization name and/or logo,
along with other organizations that have registered as Leadership Organizations, on the Award program
Website and all other Award materials.

Printed Name

Signature

Date

Please return via fax to the President's Volunteer Service Awards program
at 202-729-8033

For internal use only:

Received By

Date

LO Packet Sent By

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Date