You must have JavaScript enabled to use this form. Requestor Contact Information Name of Requestor Phone Number Email Requestor's Job Title/Position Name of office/organization Purpose of Certificate Honoree(s) Information Name on Certificate (if multiple, please attach file below instead) Suggested language/Awardee’s Bio (if multiple, please attach file below instead) If multiple individuals, please upload document with names and bios One file only.200 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Date Needed By How would you like the certificate to be presented? Mailing Address Presented by Asm. Bonta's Office Please provide event details in our meeting/event request form (https://scheduling.assembly.ca.gov/a18) after submitting the Certificate Request. Address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code