2025 Outstanding Service Provider Award Nomination Form

Outstanding Service Provider: This award is given to a direct service provider who has gone above and beyond the call of duty to assist crime victims. You may make your nomination based on your own personal story or on what you have observed. Briefly describe how this individual has impacted the life of a crime victim.

Name of individual making nomination:

First Name

Last Name

Phone

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###

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Email Address

Nominee's full name:

First Name

Last Name

Nominee's email:

Provide up to three characteristics and indicate why they best describe the nominee:

Provide up to three examples of how the nominee has gone above and beyond the call of duty to assist crime victims (include any honors and awards received):

At time of nomination, is the nominee a certified “Victim Service Provider”?

Relationship with the nominee?

OPTIONAL: In 100 words or less, please summarize your reasons for nominating this individual:

2025 Outstanding Service Provider Award Nomination Form

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