Request a Celebratory Certificate or Letter of Recognition from the Secretary of State

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Weber, Ph.D., we are honored to recognize California citizens who serve their community. Please complete the form below and submit at least 30 business days before the recognition is needed. Submission of this request will be reviewed and processed by the Secretary of State. Submission of this request does not guarantee that it will be fulfilled.</p> <div id="formidable_container_48" class="formidable "> <div id="formidable_message_48" class="formidable_message"> </div> <form id="ff_48" name="formidable_form" method="post" class="" action="https://www.sos.ca.gov/formidable/dialog/formidable"> <input type="hidden" name="formID" id="formID" value="48"> <input type="hidden" name="cID" id="cID" value="18738"> <input type="hidden" name="bID" id="bID" value="54020"> <input type="hidden" name="resolution" id="resolution" value=""> <input type="hidden" name="ccm_token" id="ccm_token" value="1732715080:cff891fc4455d397a74111f225f598c3"> <input type="hidden" name="locale" id="locale" value="en_US"> <input type="hidden" name="step" id="step" value="0"> <div class="formidable_column width-12 last"> <div class="formidable_row " > <div class="element type-of-request-813"> <label for="type-of-request-813"> Type of request <span class="required">*</span> </label> <div class="input" > <select name="type-of-request-813[]" id="type-of-request-813" placeholder='Please select' class=' form-control'> <option value="">Please select</option> <option value="Certificate of Recognition" >Certificate of Recognition</option> <option value="Letter of Recognition" >Letter of Recognition</option> <option value="Resolution" >Resolution</option> </select> </div> </div> <div class="element does-this-recognition-need-to-be-mailed-814"> <label for="does-this-recognition-need-to-be-mailed-814"> Does this recognition need to be mailed? <span class="required">*</span> </label> <div class="input" > <select name="does-this-recognition-need-to-be-mailed-814[]" id="does-this-recognition-need-to-be-mailed-814" placeholder='Please select' class=' form-control'> <option value="">Please select</option> <option value="Yes" >Yes</option> <option value="No" >No</option> </select> </div> </div> <div class="element who-is-the-best-contact-to-return-this-recognition-to-877"> <label for="who-is-the-best-contact-to-return-this-recognition-to-877"> Who is the best contact to return this recognition to? <span class="required">*</span> </label> <div class="input" > <input type="text" id="who-is-the-best-contact-to-return-this-recognition-to-877" name="who-is-the-best-contact-to-return-this-recognition-to-877" value="" placeholder="First name" class="form-control ccm-input-text" /> </div> </div> <div class="element who-is-the-best-contact-to-return-this-recognition-to-last-name-878"> <div class="label-hidden"></div> <div class="input" > <input type="text" id="who-is-the-best-contact-to-return-this-recognition-to-last-name-878" name="who-is-the-best-contact-to-return-this-recognition-to-last-name-878" value="" placeholder="Last name" class="form-control ccm-input-text" /> </div> </div> <div class="element email-address-836"> <label for="email-address-836"> Email Address <span class="required">*</span> </label> <div class="input" > <input type="email" id="email-address-836" name="email-address-836" value="" class="form-control ccm-input-email" /> </div> </div> <div class="element phone-number-837"> <label for="phone-number-837"> Phone Number <span class="required">*</span> </label> <div class="input" > <input type="tel" id="phone-number-837" name="phone-number-837" value="" class="form-control ccm-input-tel" /> </div> </div> <div class="element address-if-applicable-838"> <label for="address-if-applicable-838"> Address (if applicable) </label> <div class="input" > <input type="text" id="address-if-applicable-838" name="address-if-applicable-838" value="" placeholder="Address 1" class="form-control ccm-input-text" /> </div> </div> <div class="element city-919"> <div class="label-hidden"></div> <div class="input" > <input type="text" id="city-919" name="city-919" value="" placeholder="City" class="form-control ccm-input-text" /> </div> </div> <div class="element state-920"> <div class="label-hidden"></div> <div class="input" > <input type="text" id="state-920" name="state-920" value="" placeholder="State" class="form-control ccm-input-text" /> </div> </div> <div class="element zip-code-921"> <div class="label-hidden"></div> <div class="input" > <input type="text" id="zip-code-921" name="zip-code-921" value="" placeholder="Zip Code" class="form-control ccm-input-text" /> </div> </div> <div class="element what-date-would-you-like-this-recognition-completed-880"> <label for="what-date-would-you-like-this-recognition-completed-880"> What date would you like this recognition completed? <span class="required">*</span> </label> <div class="input" > <input type="text" id="what-date-would-you-like-this-recognition-completed-880_date" name="what-date-would-you-like-this-recognition-completed-880_date" value="" class="form-control datepicker form-control ccm-input-text" /><input type="hidden" id="what-date-would-you-like-this-recognition-completed-880" name="what-date-would-you-like-this-recognition-completed-880" class=" form-control datepicker" value="" /> </div> </div> </div> </div> <div class="formidable_column width-12 last"> <div class="formidable_row " ><h2 class="" name="honoree-information-817" id="honoree-information-817">Honoree Information</h2> <div class="element full-salutation-of-recipient-818"> <label for="full-salutation-of-recipient-818"> Full salutation of recipient </label> <div class="input" > <input type="text" id="full-salutation-of-recipient-818" name="full-salutation-of-recipient-818" value="" placeholder="Doctor, Captain, Honorable, etc." class="form-control ccm-input-text" /> </div> </div> <div class="element full-salutation-of-recipient-879"> <label for="full-salutation-of-recipient-879"> Full salutation of recipient <span class="required">*</span> </label> <div class="input" > <input type="text" id="full-salutation-of-recipient-879" name="full-salutation-of-recipient-879" value="" placeholder="First name" class="form-control ccm-input-text" /> </div> </div> <div class="element full-salutation-of-recipient-last-name-881"> <div class="label-hidden"></div> <div class="input" > <input type="text" id="full-salutation-of-recipient-last-name-881" name="full-salutation-of-recipient-last-name-881" value="" placeholder="Last name" class="form-control ccm-input-text" /> </div> </div> <div class="element please-describe-why-the-recipient-should-be-honored-by-the-california-secretary-of-states-office-820"> <label for="please-describe-why-the-recipient-should-be-honored-by-the-california-secretary-of-states-office-820"> Please describe why the recipient should be honored by the California Secretary of State's Office <span class="required">*</span> </label> <div class="input" > <textarea id="please-describe-why-the-recipient-should-be-honored-by-the-california-secretary-of-states-office-820" name="please-describe-why-the-recipient-should-be-honored-by-the-california-secretary-of-states-office-820" class="form-control"></textarea> <div class="help-block"> <div id="please-describe-why-the-recipient-should-be-honored-by-the-california-secretary-of-states-office-820_counter" class="counter" type="words" min="0" max="200"> You have <span id="please-describe-why-the-recipient-should-be-honored-by-the-california-secretary-of-states-office-820_count">200</span> words left. </div> </div> </div> </div> <div class="element will-this-recognition-be-displayed-at-an-event-if-so-please-describe-the-event-821"> <label for="will-this-recognition-be-displayed-at-an-event-if-so-please-describe-the-event-821"> Will this recognition be displayed at an event? If so, please describe the event </label> <div class="input" > <textarea id="will-this-recognition-be-displayed-at-an-event-if-so-please-describe-the-event-821" name="will-this-recognition-be-displayed-at-an-event-if-so-please-describe-the-event-821" class="form-control"></textarea> <div class="help-block"> <div id="will-this-recognition-be-displayed-at-an-event-if-so-please-describe-the-event-821_counter" class="counter" type="words" min="0" max="200"> You have <span id="will-this-recognition-be-displayed-at-an-event-if-so-please-describe-the-event-821_count">200</span> words left. </div> </div> </div> </div> <div class="element date-of-the-event-822"> <label for="date-of-the-event-822"> Date of the event </label> <div class="input" > <input type="text" id="date-of-the-event-822_date" name="date-of-the-event-822_date" value="" class="form-control datepicker form-control ccm-input-text" /><input type="hidden" id="date-of-the-event-822" name="date-of-the-event-822" class=" form-control datepicker" value="" /> </div> </div> </div> </div> <div class="formidable_column width-12 last"> <div class="formidable_row " ><h2 class="" name="organization-information-823" id="organization-information-823">Organization Information</h2> <div class="element name-of-organization-824"> <label for="name-of-organization-824"> Name of organization </label> <div class="input" > <input type="text" id="name-of-organization-824" name="name-of-organization-824" value="" class="form-control ccm-input-text" /> </div> </div> <div class="element mission-of-organization-825"> <label for="mission-of-organization-825"> Mission of organization </label> <div class="input" > <input type="text" id="mission-of-organization-825" name="mission-of-organization-825" value="" class="form-control ccm-input-text" /> </div> </div> <div class="element who-does-the-organization-serve-826"> <label for="who-does-the-organization-serve-826"> Who does the organization serve? </label> <div class="input" > <textarea id="who-does-the-organization-serve-826" name="who-does-the-organization-serve-826" class="form-control"></textarea> <div class="help-block"> <div id="who-does-the-organization-serve-826_counter" class="counter" type="words" min="0" max="100"> You have <span id="who-does-the-organization-serve-826_count">100</span> words left. </div> </div> </div> </div> </div> </div> <div class="formidable_column width-12 last"> <div class="formidable_row " > <div class="element brief-biography-of-the-recipient-827"> <label for="brief-biography-of-the-recipient-827"> Brief biography of the recipient <span class="required">*</span> </label> <div class="input" > <textarea id="brief-biography-of-the-recipient-827" name="brief-biography-of-the-recipient-827" class="form-control"></textarea> <div class="help-block"> <div id="brief-biography-of-the-recipient-827_counter" class="counter" type="words" min="0" max="500"> You have <span id="brief-biography-of-the-recipient-827_count">500</span> words left. </div> </div> </div> </div> <div class="element accolades-of-recipient-828"> <label for="accolades-of-recipient-828"> Accolades of recipient </label> <div class="input" > <textarea id="accolades-of-recipient-828" name="accolades-of-recipient-828" class="form-control"></textarea> <div class="help-block"> <div id="accolades-of-recipient-828_counter" class="counter" type="words" min="0" max="100"> You have <span id="accolades-of-recipient-828_count">100</span> words left. </div> </div> </div> </div> </div> </div> <div class="formidable_column width-12 last"> <div class="formidable_row " ><h2 class="" name="requestor-information-829" id="requestor-information-829">Requestor Information</h2> <div class="element requestors-full-name-883"> <label for="requestors-full-name-883"> Requestor's full name <span class="required">*</span> </label> <div class="input" > <input type="text" id="requestors-full-name-883" name="requestors-full-name-883" value="" placeholder="First name" class="form-control ccm-input-text" /> </div> </div> <div class="element requestors-full-name-last-name-884"> <div class="label-hidden"></div> <div class="input" > <input type="text" id="requestors-full-name-last-name-884" name="requestors-full-name-last-name-884" value="" placeholder="Last name" class="form-control ccm-input-text" /> </div> </div> <div class="element requestors-email-address-831"> <label for="requestors-email-address-831"> Requestor's email address <span class="required">*</span> </label> <div class="input" > <input type="email" id="requestors-email-address-831" name="requestors-email-address-831" value="" class="form-control ccm-input-email" /> </div> </div> <div class="element requestors-phone-number-832"> <label for="requestors-phone-number-832"> Requestor's phone number <span class="required">*</span> </label> <div class="input" > <input type="tel" id="requestors-phone-number-832" name="requestors-phone-number-832" value="" class="form-control ccm-input-tel" /> </div> </div> </div> </div> <div class="formidable_row"> <div class="formidable_column width-12"> <div class="formidable_column_inner"> <div class="element"> <div class="label-hidden"></div> <div id="ff_buttons" class="buttons col-sm-9"> <input type="submit" class="btn ccm-input-submit submit btn btn-primary" id="submit" name="submit" value="Submit" /> <div class="please_wait_loader"><img src="https://www.sos.ca.gov/packages/formidable_full/images/loader.gif" alt="Please wait..."></div> </div> </div> </div> </div> </div> </form> </div> </div> <div id="left-sidebar" class="col-md-3 col-sm-4 col-md-pull-9 col-sm-pull-8"> <nav aria-label="Executive"> <h2><a href="/administration">Executive</a></h2> <ul class="sbNav noaccordion"> <li><a href="/administration/about-agency/">About the Agency</a></li> <li><a href="/administration/about/">About Shirley N. 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