Nomination Form
(Please type or print clearly.)

Nominee Information

If you are nominating an organization or program, please provide the information below for the individual who would accept the award on behalf of that organization or program.

Type of Award
National Crime Victim Service Award
Award for Professional Innovation in Victim Services
Special Courage Award
Volunteer for Victims Award
Crime Victims Fund Award
Federal Service Award

Full name of nominee __________________________________________

Name for award plaque (if different from full name) __________________________

Is the individual, organization, or program being nominated for more than one award?
Yes            No

Mailing address ____________________________________________

City ________________ State _________ ZIP _________

Telephone number (___)_________ Fax number (___)_________

E-mail ____________

Date of birth: Month ______ Day ______ Year ______

Social Security number __________________

The nominee must sign below. Otherwise, the nomination will not be accepted for consideration. The signature authorizes the Office for Victims of Crime, U.S. Department of Justice, to conduct a criminal history background check.

Signature of nominee ________________________________________
If the nominee is an organization, program, or team, the signature of the individual authorized to accept the award is needed.

Nominator Information

Name ___________________ Title or position __________________________

Mailing address ____________________________________________

City ________________ State _________ ZIP _________

Telephone number (___)_________ Fax number (___)_________

E-mail ___________________________________

To the best of my knowledge, all of the information contained in this application is true and correct.

Signature of nominator ________________________________________

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Deadline for Nominations

Your nomination form and supporting materials must be received no later than October 31, 2003. Your nomination package should be mailed to

Office for Victims of Crime
Attention: National Crime Victims' Rights Week Committee
810 Seventh Street NW.
Washington, DC 20531

Or fax your nominations to 202-514-6383 or 202-305-2440.

Please be advised that due to increased mail handling security measures, mail sent via the U.S. Postal Service (USPS) may be significantly delayed in reaching OVC. Nominators are encouraged to fax their nomination packages or to consider alternatives to USPS such as commercial carriers. If nominations are submitted by fax, only one copy of the package is required. If a nomination is delayed in the mail and does not reach OVC by the deadline date, it will not be considered.

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FAQs About the National Crime Victims' Rights Week Awards

Q. May I nominate an individual or organization for more than one award?

A. Yes. However, a separate nomination form and nomination package for each award must be submitted, and each package must indicate that the individual, organization, or program is being nominated for more than one award.

Q. If I submitted a nomination in a past year, is it necessary for me to submit a new nomination?

A. Yes. However, any eligible nominee who has been nominated in the past continues to be eligible until selected for an award.

Q. Will I be notified if my nominee is selected?

A. No. We will contact the nominee directly if he or she is selected for an award. However, if your nominee is not selected, we will notify you in writing.

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