E Award Order Form

PRESIDENT'S VOLUNTEER SERVICE AWARD FORM E
AWARD ORDER FORM
This form can only be completed by a Certified Organization. Please type or
print using blue or black ink.
Name of Organization:
Contact Name:
Street Address:
City:
Phone:
Email:

State:
Fax:
Date of Ceremony:

NUMBER
OF AWARDS

Description:
PVSA PACKAGE 1

Zip:

(one of each)

Unit Price
$3.00

Subtotal

Personalized Certificate
Lapel Pin
Letter from the President
Letter from the President's Council on Service & Civic Participation

PVSA PACKAGE 2 (one of each)

$2.00

Personalized Certificate
Letter from the President
Letter from the President's Council on Service & Civic Participation

PVSA FAMILY/GROUP PACKAGE

$3.00

(one of each)

For additional pins & letters for each member see Individual volunteer package.
Personalized Family/Group Certificate
Lapel Pin
Letter from the President
Letter from the President's Council on Service & Civic Participation

$2.00

FAMILY/GROUP- Individual Volunteer Package
AVAILABLE ONLY WITH FAMILY/GROUP PACKAGE
Lapel Pin and Letter from the President

CALL TO SERVICE AWARD (4000 Hours)

$3.00

(one of each)

Personalized Certificate
Lapel Pin
Letter from the President
Letter from the President's Council on Service & Civic Participation

SHIPPING/HANDLING

SHIPPING/HANDLING

Order Total
$1.00- $10.00
$10.00- $24.99
$25.00- $49.99
$50.00- $99.99
$100 or more

Standard delivery is 20 Business days

S/H Fee
$6.00
$7.00
$8.00
$9.00
9% of total

RUSH FEE ($25.00)
Rush Delivery is 10 Business days

TOTAL AMOUNT DUE:
(Price includes subtotal + applicable S/H Fees+ Rush Fee)

PAYMENT (All orders must be accompanied by payment and award certification form. DO NOT SEND CASH.)
Please select method of payment
Check (please make payable to President's Volunteer Service Award.)
Credit Card
Name:
Card #

AMEX

VISA

MASTER CARD
Exp.

Please mail or fax the completed certification form, along with check or credit card information to:
President's Volunteer Service Award
C/O Points of Light Foundation
P.O. Box 10119-001
Uniondale, NY 11555-0119
FAX: 1-202-729-8033

For additional information:
www.presidentialserviceawards.gov
email: [email protected]

OMB Control #: 3045-0086
See reverse for Public Burden Statement and Privacy Act Notice

Expiration Date: 02/28/2007

Public Burden Statement: The public burden for this collection of information is estimated
to average 20 minutes per submission, including reviewing instructions, gathering the data
needed, and completing the form. Comments on the burden or content of this instrument may
be sent to the Corporation for National and Community Service, Office Public Affairs, 8th
Floor, Attn: Ms. Rhonda Taylor, 1201 New York Avenue, N.W., Washington, D.C., 20525.
The Corporation informs people who may respond to this collection of information that they
are not required to respond to the collection of information unless the OMB control number
and expiration date displayed are current and valid. (See 5 C.F.R.1320.5(b)(2)(i)).
Privacy Act Notice: The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following
notice be provided to you. The authority for collecting this information is contained in
Executive Order 13285, signed January 29, 2003. The principle purpose for collecting this
information is to recognize individuals, schools and organizations that excel in their efforts to
support volunteer service and civic participation, especially with respect to students in primary
and secondary schools, and institutions of higher learning. The information will be used to
select winners of the President’s Volunteer Service Awards and the Call to Service Awards.
Nominations for these awards are voluntary. All information that is provided to the
Corporation and its administrating organization will not otherwise be disclosed to entities
outside of the Corporation without the approval of the individual or organization nominated
for the award.