Constituent Recognition Request Form

Office of New York State Assemblymember Sam Berger – District 27
Assemblymember Sam Berger is proud to recognize outstanding residents, students, organizations, groups, and local business owners who are making meaningful contributions to the well-being and advancement of their communities in Assembly District 27.

To honor these individuals and entities, the Assemblymember offers various forms of acknowledgment, including Certificates of Appreciation, Certificates of Merit, Official Citations, and, for exceptional service, a formal Proclamation.

If you know someone deserving of recognition, please complete and submit the Acknowledgment Request Form below. A member of our staff will follow up within three to five (3–5) business days.

Please plan ahead: We strongly encourage submitting requests with ample notice. We ask that you allow seven to ten (7–10) business days for processing from the time we receive the request.

All nominations will be carefully reviewed. The Office of Assemblymember Sam Berger reserves the right to decline any request at its discretion.