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Certificate Request Form

Certificate of Recognition can be requested to honor individuals or organizations for any of the following reasons:

  • Significant contributions to the local community or the State of California
  • Special achievements by residents, businesses, or organizations of the 55th Assembly District
  • In Memoriam certificates upon the passing of an upstanding community member
  • To mark organizational milestones (e.g. business/organization anniversary, the opening or expansion of a facility, etc.)

Certificate requests are approved at the discretion of Assemblymember Bryan and his staff.

Minimum Processing Times for Certificates

  • Single, 1 week
  • Multiple, same inscription, 1-2 weeks
  • Multiple, unique inscriptions, Varies
Event Information
One file only.
200 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf, doc, docx.
Contact Name, Phone, and Email
Will you be submitting a request for Assemblymember Bryan or a member of his staff to attend this event?
If yes, please also complete an Event Request.
Honoree Information
*Enter the following information exactly as you wish it to appear on the certificate.
Is the Honoree a resident of or headquartered in the 55th Assembly District?
If requesting a certificate In Memoriam, please include date of birth and date of passing.