Online Reference Form

NOTE TO SPONSORS: “Republican Sponsors” are those sponsors who are elected Republican officials or activists. “Community Sponsors” are those sponsors who are leaders in the applicant’s hometown. Please be sure to complete the correct sponsor form. If you are not sure which form to complete, please ask your applicant.

* Sponsor Type:	Republican Community
* First Name:
* Last Name:
* Position:
* Address:
* City, State, Zip:	,
* E-Mail Address:
* Phone #:	--
*	I hereby nominate as a candidate for the Vesta Roy Excellence in Public Service Series. I am a member of the Republican Party in good standing and am not related to the nominee.
* Please explain how you know the nominee and for how long, and why she should be considered for the program:
* Please enter the characters in the image on the right: