Group/Agency/Facility Achievement
One award will be presented to a group/agency/facility that has
contributed to the field of juvenile justice
through a particular training program, or through innovative use
of the training function (e.g., for organizational change). |
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| NAME(S) |
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______________________________________________________________ |
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Please note primary contact person |
| TITLE |
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______________________________________________________________ |
| AGENCY |
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______________________________________________________________ |
| ADDRESS |
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______________________________________________________________ |
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______________________________________________________________ |
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______________________________________________________________ |
| PHONE |
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(W) ______________________ (H) ______________________ |
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Brief Description of the Group/Agency/Facility Achievement:
Please include information about the work of the group/agency/facility
and its
importance to the field of juvenile justice 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 will be contacted for candidate information |
| NAME |
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______________________________________________________________ |
| PHONE |
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______________________ Ext. ______________________ |
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| NOMINATOR |
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| NAME |
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______________________________________________________________ |
| TITLE |
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______________________________________________________________ |
| ADDRESS |
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______________________________________________________________ |
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______________________________________________________________ |
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______________________________________________________________ |
| PHONE |
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______________________ Ext. ______________________ |
| FAX |
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______________________ |
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| * Submit form to: |
|
Richard Brunner
Bureau of State Children and Youth Programs
4th Floor Bertolino Building
PO Box 2675
Harrisburg, PA 17105
or FAX: 717-787-7753
Nominations
must be received by August 15, 2008 |