Governor’s Civic Engagement Award (Individual)

Step 1 of 2

The student has been actively involved in efforts to register fellow students to vote.

The student was employed by their county as a poll worker during an election this past year.

The student must be nominated by an educator or county election official.

Student First Name

Student Last Name

Student Email

Student Phone (XXX-XXX-XXXX)

School Name

School Address

City

State

Zip Code

County

Recommender First Name

Recommender Last Name

Recommender Position

Recommender Email

Recommender Phone (XXX-XXX-XXXX)

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