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Office of Senator Josh Newman - Certificate of Recognition Request Form

Please provide the following information to submit your certificate request. Questions marked with an asterisk are required. If you have any questions or need assistance, please contact Tiffany.Lee@sen.ca.gov or call 714-525-2342.

The name appearing here will be the point of contact for this certificate request.
What is the best email address to reach you or the point of contact regarding this request?
Phone Number
What is the best phone number to reach you or the point of contact regarding this request?
  • {name}
Who in Senator Newman's office have you been working with?
Select the staffer from whom you received this form.
Name of Individual(s) to be Recognized / Occasion to be Commemorated
If you have a long list of recipients (more than 5), please type in a general description of the recipients or occasion here (e.g., "Love Buena Park 2022 volunteers", "Walnut Veterans Day Ceremony 2022") and attach an Excel sheet instead.
  • {name}
Attach file:
Attach file
Drop files here
In what city is the recipient or occasion based?
We ask that all requests be made at least one week in advance.
Notes
Any additional information you'd like to share
  • {name}

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