Legacy Form - California Nevada District

Legacy of the Year (Legacy) Award
District Nomination Form

2024 - 2025

NOTE: This Electronic Form is for Exchange Clubs to submit their Local Club Winners Only.

Deadline for submission is April 15th

ONE APPLICATION PER FINALIST

Incomplete submissions will not be considered.

Submitters Name(Required)

Submitter's Email(Required)

Exchange Club Information

Exchange Club(Required)

Exchange Club President Name(Required)

Legacy Exchange Member Information

Legacy Exchange Club Member Name(Required)

Who is the Individual sponsoring this Student that is a parent/grandparent/great grandparent?

Legacy Exchange Club Member Email(Required)

Legacy Exchange Club Member Phone(Required)

Name of Exchange Club for Legacy Club Member(Required)

Please name the Exchange Club the Legacy Club Member has a membership.

Legacy Exchange Club Member(Required)

Is the Legacy Exchange Club Member current and active in the Club?

Yes

Students Sponsor Information

Sponsor can be a Parent, Grandparent, Great Grandparent or School Official.

Students Sponsor Name(Required)

Who is the Individual sponsoring this Student?

Students Sponsor Email(Required)

Email of the Individual Sponsoring this Student?

Students Sponsor Phone(Required)

Phone Number of the Individual Sponsoring this Student?

Sponsor Narrative(Required)

The Parent / Grandparent / Great Grandparent or School Official to describe why you feel the candidate should earn the Legacy of the Year Award; include implications for the future. (3000 Characters or 500 words maximum)

Student Information

Student Name(Required)

Student Address(Required)

Student Email Address(Required)

Student Cell Phone(Required)

Student Date of Birth(Required)

Date of Graduation(Required)

Student High-resolution (150 dpi minimum) digital photo

Max. file size: 10 MB.

Parents or Guardian Information

Parents or Guardian Name(Required)

Parent or Guardian Email(Required)

Parents or Guardian Phone(Required)

High School / Counselor Official Information

Please provide the name of high school official that certified information on original application

Name of Students High School(Required)

Students High School: City & State(Required)

Students Counselor/Contact Person(Required)

Students Counselor/Contact Person Email(Required)

Students Counselor/Contact Person Phone Number(Required)

Narratives Student

Student Narrative A - (3000 Characters or 500 Words Maximum)(Required)

AS SUBMITTED BY THE STUDENT NOMINEE - Describe, in your own words, the event (or events) in your life of which you are most proud. Also describe your future plans for making your community, and the world, a better place to live. Include a paragraph about your parent/grandparent/great grandparent and your perspective of what they have done. (3000 Characters or 500 words maximum)

Certification Submission

Application Certification(Required)

I certify that the information I am submitting regarding the above named student has been verified.

Yes

Travel Certification(Required)

I verify that if this nominee is designated a winner, they will be able to accept the award in person, during the scheduled event, and are available and willing to attend the Convention from Wednesday through Sunday.

Yes

Sponsoring Club Certification(Required)

If the student is designated a winner, the above named Exchange Club Sponsor from the will be responsible for the nominee’s attendance at Exchange’s District Convention.

Yes

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Legacy of the Year (Legacy) AwardDistrict Nomination Form