On behalf of the California State Legislature, I am honored to acknowledge the accomplishments, achievements and good works of the constituents of Assembly District 33. Please complete the form below and submit at least 30 business days before the recognition is needed. Fulfillment of this request is pending approval. Office staff will update you via email.
Organization or Agency requesting the recognition:
Requestor's name: *
Requestor's contact phone number: *
Requestor's contact email: *
Is there more than one recipient? (For example, multiple owners of a business or participants in a project, list of graduates, etc.) *
Recipient's first and last name. For more than one recipient, type 'other': *
Is the recipient an organization or business?
Date to be printed on the certificate or resolution: *
Will there be an event to present the certificate or resolution? *
Would you like staff to make the presentation at an event? *
What type of recognition is being requested: *
Reason for Special Recognition: *
For framed biographical or memorial resolutions please include a one-page biography below. Essential details to include in the requested biography are: history of the person or organization including birth or inception and place, positions held both professionally and as a volunteer, a quote from a supervisor or respected colleague, family life and future plans.
If additional space is needed please email to assemblymember.mathis@assembly.ca.gov in addition to submitting this form.