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Department of State
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
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Zip Code
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Statewide
Recommender First Name
Recommender Last Name
Recommender Position
Recommender Email
Recommender Phone (XXX-XXX-XXXX)
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