Copy of Christine Milosich Public Safety Service to Youth Award

Nomination Form

Presented by the Town of Tonawanda Youth Board

1. This Award is presented to an individual 21 years or over, in the field of public safety (eg. police, fire, paramedics, crossing guards, security guard, dispatchers, liaisons, etc.).
2. He/She must have had some impact on the youth of the Village of Kenmore or the Town of Tonawanda.
3. He/She must have given over and above what is required through their normal job or volunteer duties.
4. The recipient must reside or work in the Town of Tonawanda/Village of Kenmore.

Past Recipients:
2021 Christine Milosich

2022 Jesse Haug

2023 William Harbin

(Current Youth Board Members are not eligible for this award)

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* 1. Name of Nominee

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* 2. Nominee's Contact Information

Company *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 3. Nominated By

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* 4. Your Contact Information

Company

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 5. Please explain the nominee's employment and involvement with youth

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* 6. # of youth the individual works with

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* 7. How long has the nominee been working with youth

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* 8. Please explain in your own words why you feel this individual should be chosen as the Christine Milosich Public Safety Service to Youth Award recipient.