Best regards,



                                   Aileen Adams
                                   Director

1. If you, the nominator, are affiliated with an organization, the letter should be submitted on official stationery and contain your signature, as well as your position, e.g., Executive Director. No anonymous nominations will be accepted.

2. The nominee's full name, date of birth, social security number, title, address, and telephone number must be submitted on the enclosed form.

3. Attach a nomination letter, not exceeding two single-spaced pages, that reflects as much as you know about your nominee's accomplishments and services in support of crime victims. The nomination letter should address each of the following seven (7) questions.
   • What activities has the nominee undertaken on behalf of crime victims?
     
   • How long has the nominee/program been serving crime victims?
     
   • What makes the nominee's/program's contribution unique or noteworthy?
     
   • If the nominee is a paid professional in the field of victim services, please describe his or her contributions that qualify as "beyond-the-call-of-duty."
     
   • What is the impact of the nominee's service or program on the community?
     
   • How have the actions of the nominee influenced attitudes, policies, or practices in victim services?
     
   • Is there anything else about the nominee/program that you would like to tell us?

4. Please keep in mind the focus areas listed in the cover letter as you write about your nominee:
   • Direct Services - where an individual has made an invaluable contribution to providing crucial victim services, the backbone of the victim assistance system.

   • Public Policy - where an individual has played a critical role in enacting public policy reforms, including local, state, or federal legislation on behalf of crime victims.

   • Public/Private Partnerships - where innovative partnerships were created, at the local, state, tribal, or federal level, to initiate programs or practices to better serve crime victims.

   • Promising Practices - where particularly innovative, replicable programs have been developed to serve crime victims in a new way or to provide services to typically underserved victim population groups.

   • Technology - where an individual has been instrumental in using technology, such as automated victim notification systems, to assist victims.

   • Advocacy - where efforts have been undertaken to establish the legal rights of crime victims; to secure better services for victims of crime; or to ensure that victims are able to access existing services.

   • Outreach - where an individual or program, through creativity and hard work, has made tremendous strides in reaching victims, especially underserved victims, such as victims of gang violence or victims living in rural areas, including Indian Country.

   • Service Coordination-where communities have created comprehensive, coordinated, multidisciplinary approaches to serving crime victims.

5. Supporting documentation, such as newspaper articles or resumes, can be attached if it is pertinent to the nominee's contributions. Only letters of support submitted with the nomination form will be accepted.

6. The entire package, including supplemental information and letters of support, may not exceed 10 pages.

Information on Nominee: (if you are nominating an organization or program, please provide the name of the Executive Director)

Name:_____________________________________________________________________

Title:____________________________________________________________________

Address:__________________________________________________________________

Telephone/Fax
Numbers:__________________________________________________________________

Date of Birth _____________ Social Security ________________________

Name of Family Member
or Close Contact _________________________________ Telephone No.:_____________

OVC makes every effort to reach out to diverse communities. The following questions about the nominee are optional:

Race_________________ Gender_________________ Ethnicity________________

Disability_________________________________________________________________

Primary area of service: Urban_______ Rural_______ Tribal_______ Federal _______

Signature of Nominee_______________________________________________________
My signature authorizes the Office for Victims of Crime within the U.S. Department of Justice to request an FBI criminal history background check.

Information on Nominator:

Name:_____________________________________________________________________

Title:____________________________________________________________________

Address:__________________________________________________________________

Telephone/Fax
Numbers:__________________________________________________________________

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