Fairfax-Falls Church Community Services Board

Fairfax County, Virginia

CONTACT INFORMATION: Emergency - 703-573-5679 Detox - 703-502-7000 (24/7)

TTY 711

8221 Willow Oaks Corporate Drive
Fairfax, Virginia 22031

Daryl Washington,
Executive Director

Spirit of Excellence Award Nomination Form

Answer both questions clearly and concisely. This is the only information by which the nomination will be rated. Adhere to the maximum word limits for questions. Be sure to click on "Submit" at the bottom of the page when you've completed the form. You'll be taken to a verification page before finally submitting your nomination.

Nominee and nominator names will not be seen by reviewers prior to rating.

Nominations for the 2021 awards ceremony will be accepted through noon on Sunday, March 7, 2021.

Questions? Review the Awards Program details or contact Joel Friedman (703-324-4433).


Your name:
Your email:
If you are a CSB employee, your position title:

If you are a CSB employee, your program/service area:

Nominee's name:

Nominee's position title:

Nominee's CSB program/service area:

Is the nominee a CSB employee?

If this is a team nomination, list additional team members (to include name, position title, and program/service area). Also identify those team members who are not CSB employees.
Select the one area for which the Nominee(s) is/are nominated:
Customer Service
Good Samaritan
Random Act of Kindness
One Fairfax

The CSB Awards Team reserves the right to reassign a nomination to a more appropriate service area.

Describe how the nominee promoted, reinforced, or exemplified the CSB vision, mission and values in the area nominated. (Maximum 500 words) Provide specific information that includes who did what, when, where and especially how it exemplified the CSB vision, mission and values.
Describe how the nominee’s promotion, reinforcement, or exemplification of the CSB vision, mission and values went above and beyond his/her routine job duties and responsibilities. (Maximum 500 words). Briefly identify the nominee’s primary day to day work responsibilities. How, specifically, did the action identified above go above and beyond the nominee’s day to day responsibilities?

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