2019 St. Anne 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) Position(s) Held Now:
(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 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. Congratulatory messages may be sent for publication in the Dinner Journal.
Send
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 above address.
Questions: Pdstanton@aol.com
347-446-8608 (cell)
718-438-4575 (h)
