GACP State Certification Service Award Request

CEO Attestment
As CEO of the agency, I respectfully request consideration by the State Certification Committee for the following award and hereby certify that the information provided is accurate to the best of my knowledge and belief.
TO CERTIFY THIS SUBMISSION IS TRUE AND ACCURATE, PLEASE ENTER YOUR FULL NAME IN THIS BOX FOR ELECTRONIC SIGNATURE AND CLICK THE RADIO BUTTON BESIDE IT.
Which award are you submitting documentation on?

MERITORIOUS AWARD - SILVER The agency has successfully maintained its certification status for ten (10) continuous years. Documentation is required.

MERITORIOUS AWARD - GOLD The agency has successfully maintained its certification status for twenty (20) continuous years. Documentation is required.

DISTINGUISHED AWARD The agency has successfully maintained its certification status for thirty (30) continuous years. Documentation is required.