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2. If you would like to request the Mayor and Town Council to issue a special certificate of commendation, recognition or achievement, please submit a formal request here.
4. Recipient's First and Last Name*
5. Recipient's Mailing Address*
7. Recipient's Email Address*
8. Is recipient a Parker resident, or have they made a contribution to benefit the Parker community?*

   1. Yes
   2. No
10. 2. Has recipient been informed of the request for special certificate of commendation, recognition or achievement?*

    1. Yes
    2. No
12. Please provide a brief description of the recipient, contribution or accomplishment.*
14. Event Date (if applicable)*
15. Desired Date for Certificate*
17. Requestor's Name*
19. Requestor's Email Address*
20. Requestor's Phone Number*
22. Delivery Options for Certificate*

    1. Pick up at Town Hall
    2. Schedule an Official Special Presentation at a Town Council Meeting
24. If you have a document, photo or file relevant to this request, please attach it here.

26. Please Note: Requests are subject to final approval by the Town Clerk. Although we would like to honor all requests, there may be an instance when requests are not approved or are modified.

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field