Nomination Form
Cliff Dochterman Award
A Scouting Service Award for Rotarians and Rotaractors
The Rotarian named below is hereby nominated to receive the Cliff Dochterman Award.
The name will appear on the award certificate as printed.
Nominee Information
Nominator Information
Note: The award will be shipped to the nominator unless otherwise directed.
1. Rotary Service Endorsement
I/We certify that the named award nominee is a Rotarian in good standing
and a member of the Rotary Club and District indicated below.
2. Scouting Service Endorsement
As the Association Executive responsible for the Scouting organization benefiting
from the service and contribution of the named Rotarian, I certify that the nominee
has rendered distinguished service to Scouting as noted in this application,
and I hereby endorse this application and nomination.
