Certificate Request Form

Certificate of Recognition can be requested to honor individuals or organizations for any of the following reasons:

Significant contributions to the local community or the State of California
Contributions or achievements must align with our office's priorities.
Special achievements by residents, businesses, or organizations of the 57th Assembly District
In Memoriam certificates upon the passing of an upstanding community member
To mark organizational milestones (e.g. business/organization anniversary, the opening or expansion of a facility, etc.)

Certificate requests are approved at the discretion of Assemblymember Elhawary and her staff.

Minimum Processing Times for Certificates

Single, 1 week
Multiple, same inscription, 1-2 weeks
Multiple, unique inscriptions, Varies

Indicates required field

Requestor Contact Information

Name of Requestor

Organization Name

Event Name

Phone Number

Address

City/Town

State/Province

ZIP/Postal Code

Purpose of Certificate

Honoree(s) Information

Name(s) on Certificate

Date on Certificate

Date Needed By

Options for getting certificate: Mail (please provide address), pickup, or presented (please provide event details)

Suggested language if any

Upload a document (preferably excel) with information if there are multiple certificates being requested

One file only.
200 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.