Gubernatorial Acclamation Request Form

* Requestor's name:

Affiliated organization (if any):

Is your organization considered a 501 (c) (3)?

* Mailing address:

* Phone number:

Example: 502-999-1234

* Email address:

* Purpose of acclamation:

* How does this agency or cause affect Kentucky or Kentuckians?

* Person or organization to be recognized:

Example: "Cystic Fibrosis Awareness Month"

* Date(s) of acclamation:

Example: Month of February 2017

* Date by which acclamation is needed:

*In order to ensure on-time delivery, acclamations must be requested 30 days prior to their due date.

* Has this acclamation been issued in previous years?

Draft language for acclamation in the form of 4-6 "Whereas" clauses:

* Whereas:

Whereas:

* Acclamation

* Please check one of the following notification options:

Please call me when the acclamation is ready and I will pick it up.

Please email me when the acclamation is ready and I will pick it up.

Please mail the acclamation to the address listed above.

I request a signing ceremony with the Governor.

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