[City of Santa Barbara] Request for a Certificate of Recognition

Section 1 of 1 in this document

On behalf of Agency/Group/Organization (if applicable)

Phone Number

The requestor is

local within Santa Barbara County

outside Santa Barbara County, but with branches or representatives in Santa Barbara County

not local to Santa Barbara

Request for a Certificate honoring

Upon this milestone occasion

Birthdate

Anniversary

Retirement

Receipt of an Award/Title/Recognition

Other

Honoree will celebrate their ______ birthday

90th

95th

100th

beyond 100th Fill in age below (must be over 100) here

Age to celebrate (over 100)

Honoree will celebrate their ______ year anniversary

Honoree will be retiring after how many years in their position?

Honoree will be retiring from what position?

Where will the honoree be retiring from?

Name of Award, Title, or Recognition received

Person, Organization, or Entity that issued the Award, Title, or Recognition

Date the Award/Title/Recognition was or will be presented to Recipient.

Please name the extenuating circumstance or milestone occasion associated with this request (do not use this section for recognition of a birthday, retirement, or award)

CERTIFICATE DETAILS AND INFORMATION

What ties to the local community does this person or entity have?

Please provide details or highlights you would like us to know about this person or entity for possible inclusion in the certificate. Specifically note how this person or entity has made a positive impact in Santa Barbara. Please include any philanthropic and volunteer efforts within the local community.

OPTIONAL: You may use this section to submit proposed verbiage for the certificate (five short paragraphs maximum). Please note that any submitted verbiage will be accepted as a suggestion, but final verbiage will be determined by the Mayor and/or City Administrator.

PRESENTATION OR PICK UP

Presentation or Pickup

I invite the Mayor or the Mayor’s designee to present the certificate at an event

A representative will pick up the completed proclamation from City Hall. (Note: certificates are not mailed due to their size (8.5” x 14”).

I request an electronic copy only. A hard copy is not needed. Please send it to the email address below

Event Name, Date, Time, and Location

Email to send an electronic copy too

Staff will contact you at the email provided to confirm receipt of your request and will work with you to finalize the details.

You may contact Holly Perea at HPerea@SantaBarbaraCA.gov with any questions.