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2. VILLAGE OF ROMEOVILLE COMMEMORATIVE PROGRAM

   Honorary Streets Application Form

   Updated September 1, 2021

4. Description:
   The Village of Romeoville is offering a unique opportunity for residents to honor a current or former community member through the Commemoration Program. The program is utilized as a way to recognize individuals that have made a significant contribution or impact on the community.
6. APPLICATION PROCESS
   The nominator should complete the appropriate form, providing detailed information about the major accomplishments in which you believe qualifies your honoree for this commemoration. Nominators should list accomplishments and services provided to the community outside the honoree’s job or scope of work. Please check area of contribution and complete the nomination statements. If the honoree’s achievement is through a specific organization, please elaborate on the scope of service and any offices held, including dates with the organization. Information on personal, educational and business background is helpful. The nominator must complete and submit the form.
   
   The Committee will then make a recommendation to the Village Board. If approved, a proclamation will be passed and presented to the family of the individual. Each application must meet the criteria as set forth, although meeting all criteria does not ensure naming rights. The Committee has the right to deny any application for any reason at any time or waive requirements as set forth. Applications with names or nick names that endorse or advocate religion or specific religious beliefs, have obscene connotations, or demean or attempt to intimidate any group based on the group’s race, ethnicity, age, gender, disability, or sexual orientation will be denied.
8. QUALIFICATIONS
   To qualify, the honoree must be deceased and had been a Romeoville resident for over 20 years, or volunteered in Romeoville for more than 20 years, as well as had made a significant contribution or impact on the community. The Village has the right to conduct a background check to confirm the information provided.
10. SELECTION
    The completed form will be reviewed to determine if all criteria has been met. If all criteria has been met, the nominee’s application will be forwarded to the Commemorative Program Committee which consists of an elected official, the Village Manager, a Village of Romeoville employee, a Non-profit representative and a Romeoville resident.
    
    For Honorary Streets and Permanent Buildings, Parks and Pavilions, the Committee will review the honoree nomination based on the following categories and score accordingly: Impact to Community (up to 3 pts.) Financial Contribution (up to 3 pts.) Active Organization Participation (up to 4 pts.) Based on total points received, the Committee will determine if the honoree will receive commemoration.
12. NOTIFICATION
    If honoree is selected, the Committee will inform the nominator and the honoree via letter. The honoree will be honored at a Village Board meeting.
16. NOMINATOR INFORMATION
18. Name
19. Email Address
21. Address
23. City
24. State
25. Zip Code
27. Home Phone
28. Work Phone
29. Cell Phone
31. Honoree Name
32. Relationship to Honoree
36. HONOREE INFORMATION
38. Name
39. Email Address
41. Address
43. City
44. State
45. Zip Code
47. Home Phone
48. Work Phone
49. Cell Phone
53. QUALIFICATIONS
55. Is the honoree deceased?

    1. Yes
    2. No
56. Was the honoree a Romeoville resident for over 20 years?

    1. Yes
    2. No
57. If yes, please indicate the years of Romeoville residency:
59. Did the honoree volunteer in Romeoville for more than 20 years?

    1. Yes
    2. No
60. If yes, please indicate how many years the honoree volunteered in Romeoville:
61. Please indicate the last four digits of driver's license number in order to complete the background check:
63. Define Area of Contribution: Please check appropriate area (s) of community service:

    1. Humanitarian Service: Promotes social reform, human welfare, aids society through philantrophy, etc.
    2. Distinguished Public Service: Non-paid service through business, government, organizations, etc.
    3. Scholarly Service: Academic achievement or studies, etc. in making a difference for the greater good.
    4. Creative Attainment: Originality and expressiveness, etc. in making a difference for the greater good.
    5. Financial: Significant donations that help better the community.
67. NOMINATION STATEMENTS
69. How did this service make a positive difference in the community? Please list specific examples.
71. Please give a detailed description of the honoree's service as defined above. List each organization that the individual actively participated in. Please note, service should be outside of regular employment or job scope.
73. Streets can be named after individuals that have made a significant impact on the community. Streets will not be named after any business or commercial entity. Please describe how this individual made a significant impact on the community through volunteerism or contributions.
77. STREET SIGN PERSONALIZATION
79. Exact name of person to appear on street sign:
80. Street Sign Location Preference:
84. CONDITIONS
86. Checking the box indicates that I certify that all statements and information furnished in this form are true, complete and correct to the best of my knowledge, and are made in good faith. I understand that statements or information furnished on this form are subject to verification and I agree to furnish supporting documents or information when requested.

    1. I have read and agree to the conditions.
90. NOMINATION REVIEW - FOR OFFICE USE ONLY
92. Does honoree meet residency requirements of over 20 years?

    1. Yes

    1. No
93. Does honoree meet volunteer requirements of over 20 years?

    1. Yes

    1. No
95. Please score all fields accordingly.
97. Impact to Community (Up to 3 pts.)

    1. Benefits one organization or group between 1-50 people (1 pt.)
    2. Benefits one organization or group 50+ people (2 pts.)
    3. Benefits entire community (3 pts.)
99. Active Organization Participation (Up to 4 pts.)
    Please list each organization that the honoree was an active participant of. One point will be given for each organization for a maximum of 4 pts.
101. Organization
102. Organization
104. Organization
105. Organization
107. Major Financial Contribution (3 pts.)

     1. Contributed $25,000 or more (3 pts.)
108. Total pts. for honoree
112. OFFICE USE ONLY
117. The completed form will be submitted via email for review and approval. For additional information, contact the Village of Romeoville at 815-886-7200.
Leave This Blank:


118. 1. Receive an email copy of this form.
119. Email address

     This field is not part of the form submission.

120. Submit

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