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Public Education & Citizenship Committee: Certificate Request Form
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Type of Certificate
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General Information
Lodge Name & Number
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Presented By (Lodge Name, Worshipful Master, etc.)
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Presenter Type
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Presented To (Award Recipient)
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Mailing Address for Certificate
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Adopt-A-School
Grade Level
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Description of Activity
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Adopt-A-Teacher 
School Name
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School Address
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Grade Level / Courses Taught
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Outstanding JROTC Cadet
Branch
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Cadet's Rank & Assignment
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Cadet's High School Name
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Cadet's High School Address
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Recommending Senior Military Instructor Name
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Recommending Senior Military Instructor Rank
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Certificate of Appreciation
Type of Certificate
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Scouting
Troop Name / Number
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Outstanding Youth Military Organization Cadet
Cadet Branch
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Cadet Name / Rank
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"Why I Love America" Essay Contest Recipient 
Recipient's Grade
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Recipient's School Name
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Recipient's School Address
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