Online forms and surveys

Print
Press Enter to show all options, press Tab go to next option

Mayor's Award Nomination Form

Please correct the field(s) marked in red below:

The Mayor's Award recognizes individuals in the community who have performed an outstanding act or good deed; or have a longstanding history of community service and volunteerism in the City of Costa Mesa. The program is open to all Costa Mesa residents and individuals who work or volunteer in the City. Mayor Sandra Genis will select individuals based upon nomination letters received from the public and will recognize the recipient(s) of the Mayor's Award at a City Council meeting.

If you wish to nominate an individual for the Mayor's Award, submit the name of your nominee as well as a brief statement as to why you think this individual deserves recognition. Please include your name, address and a phone number at which you can be contacted. This information can be submitted by mail to: Mayor's Award, City of Costa Mesa, PO Box 2100, Costa Mesa, California, 92628-1200; by fax to (714) 754-5330; or email using the following form:

1
I wish to nominate:
2
For the following reasons:
3
Your Name:
4
Your Address:
5
City - State - Zipcode:
6
Your Phone Number:
7
E-mail Address:

Before you submit this e-mail form, we would like you to be aware of the City's policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send:

(1) is subject to public disclosure under the Public Records Law, 
(2) is not private or confidential.

  1. To receive a copy of your submission, please fill out your email address below and submit.