Form

S&TI Champion Award Program Application

Award candidates must be NOMINATED by one person and a second person must VALIDATE the nomination. Please have information from both parties before you complete and submit the form.

DEADLINE Oct 25, 2024

Please provide information about the NOMINEE:

First Name Last Name of Nominee*

Company of Nominee*

Job Title of Nominee*

Email of Nominee*

Award*

IMPORTANT: Nominations for the Case Practice category must respect the anonymity of clients. The description of any case details cannot include any identifying information. This includes names, locations, or any other case details that would make the case identifiable.

Champion Award for Excellence in Case Practice

Champion Award for Excellence in Systems Change

Awards are presented during Safe & Together conferences. Which conference might the nominee attend: Asia Pacific, European, or North American?

Conference Location*

Experience of Nominee*

How much training has the nominee had?

Please provide information about the NOMINATOR:

First name of Nominator*

Last name of Nominator*

Email of Nominator*

Company name of Nominator*

Related Agency Customer Category

Country Name*

Contact Regional Location*

Job Title*

Nominating Reason*

Nominator: Describe why the person you are nominating should receive the award. IMPORTANT! Award winners will be decided based on how detailed and specific the Nominator is about the actions this person has taken, as well as how effectively the Nominator can articulate how those actions have had an impact on families and/or colleagues. Therefore, the Nominator must highlight both the practice change AND the impact of that practice change.

Please enter information about the VALIDATOR:

First Name and Last Name of Validator*

Job Title of Validator*

Company of Validator*

Email of Validator*

Nominating Reason of Validator

Describe why the person you are nominating should receive the award. IMPORTANT! Award winners will be decided based on how detailed and specific the Validator is about the actions this person has taken, as well as how effectively the Validator can articulate how those actions have had an impact on families and/or colleagues. Therefore, the Validator must highlight both the practice change AND the impact of that practice change.

Supporting Documentation

Upload supporting evidence or documentation of the effects of their efforts and the connection back to S&TI (supporting documents, validations, letters of support) here.

Thank you!

The nominations will be reviewed by Safe & Together Institute staff members.

For any questions or issues submitting this form, please contact us.