BeSafe Awards – Nomination Form

BESAFE AWARDS

Advocacy Award recognizes the following attributes in recipients:

  • Acting to call attention to complex issues
  • Giving voice to the voiceless
  • Through relationships based upon partnership and empathy, offering knowledge, skills and

confidence to advance goals of people they serve

Collaboration Award is presented to partners who:

  • Build bridges across organizations and sectors
  • Create a mindset that values, and an infrastructure that fosters, joint action
  • Set aside individual and organizational prerogatives to achieve a broader community objective

Innovation Award recognizes the following attributes in recipients:

  • Bringing a fresh and optimistic perspective to a challenging issue
  • Utilizing resources creatively
  • Taking risks to achieve goals

Leadership Award recognizes the following attributes in recipients:

  • Taking a strategic, big picture view with an eye toward long-term success
  • Holding oneself to the highest standards of performance
  • Recognizing and celebrating accomplishments and contributions of partners

NOMINATION REQUIREMENTS

  • Answers to the questions on the following page will be used as criteria for determining the award recipients. It is important to answer EACH question.
  • Please be as detailed and specific about the nominee as possible with the 2 page limit of the nomination. The review committee will rank the nominees based solely on the information and answers you provide.
  • The responses must be typewritten (12 point font) and no longer than 2 pages.

HOW TO SUBMIT YOUR NOMINATION: Email your nomination to and staff will confirm the receipt of your nomination. If you have questions, please contact Safe Communities at 608.441.3060

nomination Timeline

  • Nomination period open: June 19th– July 28th
  • ALL NOMINATIONS DUE: Monday, July 31st
  • Award winners notified:Week of August 14th

BeSafe Awards, October 19, 2017

Maple Bluff Country Club

4:30 pm -6:30 pm

CONTACT INFORMATION

NAME OF NOMINEE (individual or organization):
Click here to enter text. / NAME OF ORGANIZATION:
Click here to enter text.
ROLE IN ORGANIZATION:
Click here to enter text.
MAILING ADDRESS:
Click here to enter text.
PHONE NUMBER:
Click here to enter text. / EMAIL:
Click here to enter text.
NAME OF INDIVIDUAL SUBMITTING NOMINATION:
Click here to enter text. / NAME OF ORGANIZATION:
Click here to enter text.
MAILING ADDRESS:Click here to enter text.
PHONE NUMBER:Click here to enter text. / E-MAIL:Click here to enter text.
  1. Please select which Safe Communities strategy area(s) the nominee’s work falls under.

BeSafe Awards – Nomination Form

☐Falls Prevention

☐Drug Poisoning

☐Suicide Prevention

☐Traffic Safety

☐Other notable area of safety/prevention (please list)

______

BeSafe Awards – Nomination Form

  1. Please select which BeSafe Award this nomination is for (Select one):

BeSafe Awards – Nomination Form

☐Advocacy Award

☐Collaboration Award

☐Innovation Award

☐Leadership Award

BeSafe Awards – Nomination Form

  1. Please describe how the nominee meets and displays the criteria for the above selected Award. (Award criteria on page 1)

Click here to enter text.
  1. How does the nominee represent and advance authentic needs of people they serve?

Click here to enter text.
  1. Is there anything else you feel the committee should know about the nominee?

Click here to enter text.