1 NOMINATION FORM FOR NAMING OR RE-NAMING
PARKS, FACILITIES OR STREETS
1. Name of Nominee:
[ ] Individual [ ] Group [ ] Organization
2. Nominated By: Name:
Address:
City and Zip:
Telephone:
Organization:
3. Proposed [ ] Facility [ ] Park [ ] Street [ ] Other Current Name:
Proposed Name:
Please indicate the category that applies to the nomination:
[ ] Service Recognition [ ] Monetary, Capital or Material [ ] Recognition of Heroes [ ] Special Feature, Area, Locale
PLEASE FILL IN ONLY THE SECTION THAT APPLIES TO THE PROPOSED NOMINATION. ADDITIONAL COMMENTS CAN BE INCLUDED ON THE SECOND (2) PAGE AND/OR OTHER RELATED MATERIALS OR COMMENTS MAY BE ATTACHED TO THIS APPLICATION.
Service Recognition: (Individual, Group, or Organization)
1. Was service provided in a voluntary non-paid status or if a group or organization, was contribution provided outside the normal function of a profit making organization? [ ] YES [ ] NO
2. Did the contribution exceed five (5) years in duration? [ ] YES [ ] NO
3. Is the nominee an elected or appointed official?
[ ] YES [ ] NO
4. Did the contribution have a direct positive effect on the delivery of public services? [ ] YES [ ] NO
5. If the nominee is DECEASED and provided service while they were in a pay status or they were an elected or appointed official, please indicate year of death.
Year of Death
A. Did the service exceed ten (10) years in duration? [ ] YES [ ] NO
Revised 01/2021
2 Monetary, Capital or Material Contribution:
1. What is the amount or value of the contribution?
$ _________________
2. Date of contribution: ______________________
3. Does nominee have a good record of citizenship?
[ ] YES [ ] NO
Recognition of Heroes:
1. Did the deed for which the nominee is being honored occur two (2) years prior to the date of consideration? [ ] YES [ ] NO
2. Is the deed for which the nominee is being honored common knowledge to the citizens of Richmond? [ ] YES [ ] NO
3. Does nominee have a good record of citizenship?
[ ] YES [ ] NO
4. Is the nominee recognized as a national hero by an agency of the United States Government? [ ] YES [ ] NO
Name of Agency:
Special Feature, Area or Locale:
1. Is this name appropriate to the facility?
[ ] YES [ ] NO
Please explain in comments section.
Comments:
Nominated by: Date:
Received in Recreation Division By:
Date:
Requested Action:
[ ] Prepare for Commissioner recommendation
[ ] Deny (Explanation)
Revised 01/2021