NC Gov. Cooper: Letter Request Form

REQUESTER INFORMATION

Requester Name *

Requester Organization/Agency *

Requester Phone *

Please format as XXX-XXX-XXXX.

Requester Email *

DELIVERY INFORMATION

Mailing Address (where the completed document should be mailed):

Recipient *

Organization (if applicable)

Street Address 1 *

Street Address 2

City *

State *

Zip Code *

HONOREE/EVENT INFORMATION

Type of Letter *

Please select the type of letter you are requesting.

Birthday (for individuals turning 80 or older)

Church/Organization Anniversary

Eagle Scout/Gold Award

Family Reunion

High School Reunion

Wedding Anniversary (for 25 years or more)

Welcome Message (for conferences, meetings, banquets, etc.)

Birthday (for individuals turning 80 or older)

Honoree Title: *

Honoree First Name: *

Honoree Middle Name:

Honoree Last Name: *

Honoree Suffix:

Honoree Address (to be included on the letter):

Honoree’s Full Name (exactly as it should appear on the letter) *

Street Address 1 *

Street Address 2

City *

State *

Zip Code *

Date of Birth *

Month

Day

Year

Age to be Celebrated: *

Details about the Event/Honoree: *

Church/Organization Anniversary

Full Name of Church/Organization: *

Pastor/Organization Leader Job Title or Position: *

Pastor/Organization Leader Title: *

(ex. Dr., Ms., Mr., Rev., etc.)

Pastor/Organization Leader First Name: *

Pastor/Organization Leader Middle Name:

Pastor/Organization Leader Last Name: *

Pastor/Organization Leader Suffix:

Church/Organization Address (to be included on the letter):

Pastor/Organization Leader Full Name (exactly as it should appear on the letter) *

Full Name of Church/Organization (exactly as it should appear on the letter) *

Street Address 1 *

Street Address 2

City *

State *

Zip Code *

Date of Event: *

Anniversary to be Celebrated: *

(Example: 140th anniversary of organization’s founding)

Details about the Event/Honoree: *

Eagle Scout/Gold Award

Honoree First Name: *

Honoree Middle Name:

Honoree Last Name: *

Honoree Suffix:

Honoree Address (to be included on the letter):

Honoree’s Full Name (exactly as it should appear on the letter) *

Street Address 1 *

Street Address 2

City *

State *

Zip Code *

Troop Number: *

Ceremony Date (if the date has not passed):

Details about the Event/Honoree: *

You must provide information that describes how the honoree qualifies for this award. If this information is not provided, your request will not be processed.

Wedding Anniversary (for 25 years or more)

Spouse 1 Title: *

Spouse 1 First Name: *

Spouse 1 Middle Name:

Spouse 1 Last Name: *

Spouse 1 Suffix:

Spouse 2 Title: *

Spouse 2 First Name: *

Spouse 2 Middle Name:

Spouse 2 Last Name: *

Spouse 2 Suffix:

Couple’s Address (to be included on the letter):

Couple’s Names (exactly as they should appear on the letter) *

Street Address 1 *

Street Address 2

City *

State *

Zip Code *

Date of Event: *

Anniversary to be Celebrated: *

(Example: 30th)

Details about Event: *

Welcome Message (for conferences, meetings, banquets, etc.)

Full Name of Event's Host Organization/Agency: *

Host Organization/Agency Leader Job Title: *

Host Organization/Agency Leader Title: *

(ex. Dr., Ms., Mr., Rev., etc.)

Host Organization/Agency Leader First Name: *

Host Organization/Agency Leader Middle Name:

Host Organization/Agency Leader Last Name: *

Host Organization/Agency Leader Suffix:

Organization/Agency Address (to be included on the letter):

Host Organization/Agency Leader Full Name (exactly as it should appear on the letter) *

Full Name of Host Organization/Agency Full Name (exactly as it should appear on the letter)

Street Address 1 *

Street Address 2

City *

State *

Zip Code *

Title/Theme of Event (if applicable): *

(Example: 30th Annual Meeting of the Organization of North Carolina – North Carolina: The State Where We Live)

Date of Event: *

Please give a detailed description of the event and its host and/or sponsoring organization: *

Correspondence to and from this website may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized state official.

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Birthday (for individuals turning 80 or older)

Church/Organization Anniversary

Eagle Scout/Gold Award

Family Reunion

High School Reunion

Wedding Anniversary (for 25 years or more)

Welcome Message (for conferences, meetings, banquets, etc.)