Commendation Request

Commendations are provided as a courtesy by Supervisor Barger and are intended to recognize individuals, community organizations, or businesses for their exceptional contributions to the people of Los Angeles County.

In order to be considered, your request must meet the following criteria:

The honoree(s) is an individual, organization, or business that resides in the 5th District
The commendation recognizes a milestone or an occasion of extraordinary significance
The honoree(s) has made a meaningful impact or contribution to the people of Los Angeles County
No prior commendation has been provided to the individual or organization for the same work or event within the last year
Commendations may not be requested for yourself
Optional for county retirements: if requesting “whereas” verbiage, please attach the language to this form at the time of submission

To request a commendation, please complete and submit the attached form below. All requests must be submitted at least four (4) weeks prior to the date needed.

The Supervisor’s office reserves the right to decline any commendation request and may rescind a request if false or misleading information was provided in the application.

All requests will be reviewed and responded to in a timely fashion.

Given the high volume of requests, the Supervisor’s office may not be able to accommodate your request even if the criteria outlined above are met.

Requester's Name*
First Last
Requester's Email*
Requester's Telephone Number*
Requester's Name of Organization*
Organization Address*
Street Address Address Line 2 City State ZIP Code
Honoree Information
Full Name of Honoree/Organization*
Home Address of Honoree*
Street Address Address Line 2 City State ZIP Code
Do they live in the 5th District?*
- Yes
- No
Reason for Honor: Please provide a statement about the honoree/organization that demonstrates the reason for their recognition.*
Type of Event and/or Title of Award*
Date to be printed on commendation*
MM slash DD slash YYYY
Please upload a bio/whereas langauge (if applicable). Word document only.
Max. file size: 5 MB.
URL(s) with additional information about the honoree/organization/event (if applicable)
Supporting Documents (if applicable). Please note: scanned whereas language will not be accepted.
Max. file size: 5 MB.
Event Information
Event Title
Presentation Request: Please note that we try to accommodate all requests for staff presentations. However, given the volume of requests received, we may not be able to attend your event.
- Yes
- No
Event Name*
Event Date*
MM slash DD slash YYYY
Event Time*

: Hours

Minutes

AM/PM
Event Address
Street Address Address Line 2 City State ZIP Code
Anything else we should know?
METHOD OF DELIVERY
Please select one:
- Pick-up
- Mail
Select a pick-up location from the drop down menu below
Submission
I understand that if I do not pick up my commendation within 10 days of notification, the scroll will be mailed to the requester's address*
- Yes
I understand that due to the high volume of requests, Supervisor Barger's office may not be able to accommodate my request, even if all outlined criteria are met.*
- Yes
I certify that the information contained in this request is accurate and complete.*
- Yes
Requester's Name*
Requester's Initials*
For questions or more information, please email us at 5dsscrolls@bos.lacounty.gov
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COMMENDATION REQUEST

COMMENDATION REQUEST

Honoree Information

Event Information

METHOD OF DELIVERY

Submission

For questions or more information, please email us at 5dsscrolls@bos.lacounty.gov