Individual Award
This award will be made to an individual(s) for contributions
and/or achievements in the field of juvenile justice training
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| NAME |
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| AGENCY |
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| ADDRESS |
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______________________________________________________________ |
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| PHONE |
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(W) ______________________ (H) ______________________ |
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Brief Background Statement:
Please include the person’s work affiliation with juvenile justice
training |
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______________________________________________________________ |
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______________________________________________________________ |
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______________________________________________________________ |
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Achievement:
Please describe the nature of the individual’s contribution to
juvenile justice training or the JJTA,
and how their efforts impacted locally, statewide, and/or nationally |
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______________________________________________________________ |
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______________________________________________________________ |
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______________________________________________________________ |
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| REFERENCE |
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References and local JJTA members will be contacted for information
on the candidate. |
| NAME |
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______________________________________________________________ |
| PHONE |
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______________________ |
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## Please include black and white photo
of the candidate ## |
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| * Submit form to: |
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Munna Rubaii
300 South Road
Brooktondale, NY 14817
or 607-539-6671
Nominations
must be received by August 15, 2010 |