DMV "Shining Star" Peer Recognition Award Submission Form

Nomination Process:

Fellow employees, supervisors, or anyone within the DMV office can make nominations.
Nominate a colleague who excels in supporting and promoting organ and tissue donation, whether by initiating donation conversations, creatively embodying the Donate Life Month theme in their personal appearance or workspace decor, or actively promoting awareness.
Submit nominations between April 1, 2024 and May 31, 2024. Include photos and/or other supporting materials that showcase their dedication.

Nominator Information

Your Name(Required)

First Last

Name of DMV office you are affiliated with(Required)

County of DMV office you are affiliated with

Your Position/Title(Required)

Your Email Address(Required)

Your Daytime Phone Number(Required)

Your Relationship to Nominee(Required)

ex: supervisor, colleague, etc.

County Clerk/District Office Manager Information

Are you the County Clerk (for County-operated DMVs)/District Office Manager (for State-operated DMVs)(Required)

Yes

Name of County Clerk (for County-operated DMVs)/District Office Manager (for State-operated DMVs)(Required)

First Last

Email Address of County Clerk (for County-operated DMVs)/District Office Manager (for State-operated DMVs)(Required)

Daytime Phone Number of County Clerk (for County-operated DMVs)/District Office Manager (for State-operated DMVs)(Required)

Nominee Information

Nominee's Name(Required)

First Last

Nominee's Position/Title(Required)

Number of years Nominee has been in current position(Required)

Does the Nominee have a personal connection to the Donate Life mission?(Required)

Yes

Prefer Not to Answer

Optional: Describe Nominee's personal connection to Donate Life mission

500 character limit

Nomination Statement

Explain why you believe this individual deserves recognition for their contributions to organ and tissue donation awareness and registration. Include specific examples of their efforts, initiatives, and impact within the DMV office or community.

Nomination Statement(Required)

1,500 character limit

Supporting Materials

Please attach a photo of the nominee and any other relevant photos, documents, or additional materials that showcase the nominee’s dedication to promoting organ and tissue donation awareness. This could include photos of their workspace decor, evidence of donation-related initiatives, etc.

File(Required)

Upload at least one picture of nominee, as well as any additional supporting materials. Up to five files can be attached.

Drop files here or

Max. file size: 8 MB, Max. files: 5.

DMV “Shining Star” Peer Recognition Award Submission Form

Nominator Information

County Clerk/District Office Manager Information

Nominee Information

Nomination Statement

Supporting Materials

Your year-end tax deductible financial contribution helps us save lives