NOTE: PLEASE USE ONE FORM FOR EACH NOMINATION YOU ARE SUBMITTING. ATTACH ALL RELATED SUPPORTIVE MATERIAL AND DOCUMENTATION.
SEND TO:
Department of Justice
Youth Justice Renewal Initiative
180 Elgin Street, 7th Floor
Ottawa, Ontario
K1A 0H8
or
Fax to: (613) 954-3294
or
E-mail to: prix.police.award@justice.gc.ca
Date nomination submitted:
Information about the Nominee(s)
Name of Police Officer(s) being nominated:
Business Address:
Email:
Telephone Number:
Fax Number:
Information about the Police Service
Name of Police Service or Department:
(Please use a separate nomination form for separate police services or
departments)
Business Address:
Email:
Telephone Number(s):
Fax Number(s):
Information about the Nominator
Name of individual(s) submitting nomination:
Address:
Email:
Telephone Number:
Fax Number:
SIGNATURE:
Information about the Commanding Officer of the Police Service
Name of Chief of Police, Commander or Director:
Business Address:
Email:
Telephone Number:
Fax Number:
SIGNATURE:
(Nominations made by a member of a police service must be reviewed and signed by the Chief of Police, Director or Commanding Officer of the agency concerned. If the nomination is made by a community group or individual, the person or group making the nomination must send a copy of the form to the Chief of Police, Director or Commanding Officer of the police service concerned.)
NOTE: Please limit the nomination to a maximum of 1500 words. Do not write on the back of the nomination form. Please include relevant supporting material or documentation.
Indicate when the program or approach for which you are nominating the officer(s) was started or significantly altered (please list changes and dates).
Describe the project or approach for which you are nominating the officer(s).
Describe how the program or approach is creative and/or innovative in dealing with youth who have come in conflict with the law.
Indicate which of the following the program or approach supports:
Describe how the program or approach provides proportionate responses to offending conduct with one or more of the following objectives in mind:
Additional Comments: