2019 St. Elizabeth Ann Seton Award Nomination Form
Diocese of Brooklyn
Catholic Committee on Scouting
MUST be returned to the CCOS no later than Friday, April 5,
2019
ABOUT THE NOMINEE
Name
Parish
Address
City/State/ZIP
Telephone
E-mail
(1) Years as an Adult Member
Indicate years with Girl Scouts_______ Camp Fire_______
Other_______
(2) List Position(s)
Currently Held:
(3) Positions Previously Held in Girl
Scouts/Camp Fire/Other:
(4) Please state specifically what contributions the candidate has made in the spiritual development of Catholic
members in the above organizations that would merit this award:
(5) Please
record other contributions of the candidate,
with positions held and dates, specifically in regard to the
activities of the parish, diocese, organization
served (Girl Scouts, Camp Fire, Other), business, civic, religious, educational organizations.
ENDORSEMENT
I hereby affirm the nomination of
as worthy of this recognition.
__________________________________________
___________________
Signature of the Parish Priest/ Pastor/ Moderator
Date
(Signature of Parish Priest/ Pastor/ Moderator)
(Date)
ABOUT THE NOMINATOR
Name
Position
Address
City/State/ZIP
Telephone
E-mail
Date
Note: Nomination
is to be kept confidential. The person making
the nomination will be notified of the results.
Awards are presented at the Bishop’s Dinner for Scouting on Wednesday, May 8, 2019 Congratulatory messages
may be sent for publication in the Dinner Journal.
Send Nomination Form to
Paul D. Stanton,
Chairman
Catholic Committee on Scouting
Diocese
of Brooklyn
2 Hinckley Place, 1L
Brooklyn, N.Y.
11218
Award Payment check in the amount of $35. Should
be made payable to CCOS and mailed to the above address.
Questions:
pdstanton@aol.com
347-446-8608 (Cell) 718-438-4575 (H)
FOR USE BY OFFICE TAFF ONLY
Approval by Catholic Committee on Scouting
The above candidate
meets diocesan requirements.
______________________________________ __________________
Chairman
Chaplain
