Virginia House of Delegates Forms

Certificate Request

The purpose of certificates is to memorialize or commend individuals or groups. Commending certificates include such distinctions as:

Deaths of prominent members of the community;
Eagle Scouts and Girl Scout Gold Awards and other local, regional, or statewide distinctions or designations, including community service achievement/awards;
Receiving first place in a local, regional, or statewide event;
Individual members on championship teams;
Retirements (20 or more years);
Significant anniversaries of organizations, businesses, churches (25-year increments);
Anniversaries (25th, 50th, 75th);
Anniversaries of Pastors with Churches (25th or more, in five-year increments); and
Birthdays (75 or older, in five year increments).

Please direct your questions to:

Fill out the fields below and submit.

Question 1

Required

Contact Name

Question 2

Contact Phone

Question 3

Required

Contact Email

Question 4

Required

Please select the certificate type

Memorial Commending

Question 5

Required

Choose One

House Joint

Question 6

Required

Name of person to be commemorated by certificate

Question 7

Required

Name of individual(s) or group(s) to be honored by certificate

Question 8

In Recognition Of

Question 9

Additional Information

Question 10

Attachment

Click here to attach a file

Question 11

Patron

Question 12

Date

Question 13

Additional Patrons

Question 14

Attachment Notes

Please review your responses before submitting.