Centenarian Recognition 

Centenarians have distinctive experiences and achievements that Brunswick County wants to recognize. Centenarians who are turning 100 or older are invited to participate in the acknowledgement of their centenarian status.

Centenarians will be recognized at a regularly scheduled monthly Board of Supervisors meeting. Centenarians are invited to attend the meeting in-person, but this is not a requirement to receive recognition. Please note, Board of Supervisors will recognize an individual once for their centenarian status.
If you have any questions, contact the Brunswick County Administration Office or by calling 434-848-3107.

Centenarian Recognition Application

Centenarian Information

• Centenarian Name*(required)
• Centenarian Certificate Display Name*(required)
• Centenarian Email*(required)
• Centenarian Phone*(required)
• Centenarian Address*(required)
• Provide the best address to receive the recognition certificate (which will be sent if unable to attend the Board of Supervisors meeting in person).
• Residential Living Facility
  • Provide the name of residential living facility, if applicable.
• Military Affiliation 
  • Provide military affiliation, if applicable.
• Age*(required)
• Contact Information Media Release *(required)
  • Yes, I approve of my contact information being provided to local media.
  • No, I do not approve of my contact information being provided to local media.
    • Please advise. 
• Brunswick County may be contacted by local media who are interested in interviewing centenarians. Please indicate if you give consent for your contact information to be provided to local media for this purpose. 
• Is the centenarian listed above the individual completing this form? *(required)
  • Yes
  • No

Centenarian Biographical Information

• Please provide, in approximately 300 words or less, centenarian biographical information that will be used as part of the Board of Supervisors recognition.
• Your Secret to Longevity
  • Please tell us your thoughts on the secret to longevity. (1,500 character limit)
• Life Achievement
  • Tell us about a life achievement that brings you joy, pride or accomplished a life goal. (1,500 character limit)
• Tell us a story about your family or childhood
• Tell us about a defining moment or tradition that has made you who you are today. (1,500 character limit)
• Tell us about a professional or volunteer achievement
• Tell us about how you have influenced your community. (1,500 character limit)
• Tell us about a current interest or hobby
• Tell us about a current passion. (1,500 character limit)

Additional Biographical Information

•  Is there anything else about you that you would like to share? (1,500 character limit)
• Centenarian Photographs
  • Upload or drag files here.
• Please provide up to three photographs (head shots preferred) of the centenarian that include both images of their younger and current selves.
  (5 MB limit for each photograph; .jpg, .jpeg, and .png file types accepted. )