2023 LER MADD Award Nomination Form (1)

MOTHERS AGAINST DRUNK DRIVING ‘ TAKE THE WHEEL ’ 2023 RECOGNITION AWARDS

Take the Wheel, an initiative of MADD North Texas, is requesting nominations from all law enforcement agencies in North Texas who have made a difference in 2022 by going above and beyond in the areas of drunk driving and underage drinking prevention, policy, training, or enforcement. These efforts are making an impact in reducing alcohol-related death and injury on North Texas roads and MADD wants to honor their hard work.

Please refrain for nominating the same individual for two categories. Categories include:

1. Enforcement Hero - Given to a law enforcement officer who has established most DWI arrests within their department.

2. Outstanding Service- Given to an officer who has made a difference in the last year by going above and beyond in the area(s) of education, prevention, or enforcement.

3. Outstanding Rookie - Given to a law enforcement officer who has established a strong commitment to MADD's mission within the local community, or diligence in DWI arrests and an outstanding record of DWI arrests. 4. Outstanding Law Enforcement Agency - Given to a law enforcement agency that is making a difference by going above and beyond in the area(s) of education, prevention, policy or enforcement and whose efforts are making an impact in reducing alcohol-related death and injury on Texas' roads.

5 .Policy Sette r- Group or agency that has shown dedication to working to save lives on local roadways by reducing impaired driving through efforts to set policy regarding DWI/DUI issues.

6. Judiciary Service - Given to a judge that has shown dedication to working in the areas of DWI/DUI education, prevention, or innovation to reduce drunk and impaired driving.

7. Prosecutor Service - Given to a prosecutor that has shown dedication working in the trenches to save lives on local roadways through their prosecution of drunk or impaired drivers.

8. Leadership Hero - Given to chiefs/commanders/captains/supervisors who have shown superior commitment to DWI enforcement by providing their departments and agencies with the resources, support, and trainings needed to reduce drunk and drugged driving. 9. Unsung Hero - Given to an individual or group, executive assistants/nurses/medical centers/group who go above and beyond the call of duty. This individual’s or group’s involvement must demonstrate a substantive contribution to Law Enforcement and/or DWI/DUI issues

10 .Community Partner - Given to a community partner who shows an outstanding dedication in areas of DWI/DUI education, prevention, or innovation to reduce underage driving and or impaired driving.

Tarrant & Denton County Luncheon - Wednesday, May 17th from 11:30 AM - 1:30 PM Dallas & Collin County Luncheon - Wednesday, June 21st from 11:30 AM - 1:30 PM

Nominations Close Date : Monday, April 3rd.

MOTHERS AGAINST DRUNK DRIVING ‘TAKE THE WHEEL’ 2023 RECOGNITION AWARDS ENFORCEMENT HERO NOMINATION FORM (PLEASE TYPE)

Enforcement Hero - Given to a law enforcement officer who has established most DWI arrests within their department.

Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION:

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023 to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

MOTHERS AGAINST DRUNK DRIVING ‘TAKE THE WHEEL’ 2023 RECOGNITION AWARDS

OUTSTANDING SERVICE NOMINATION FORM (PLEASE TYPE)

Outstanding Service- Given to an officer who has made a difference in the last year by going above and beyond in the area(s) of education, prevention, or enforcement.

Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION:

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023 to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

MOTHERS AGAINST DRUNK DRIVING ‘TAKE THE WHEEL’ 2023 RECOGNITION AWARDS OUTSTANDING ROOKIE NOMINATION FORM (PLEASE TYPE)

Outstanding Rookie - Given to a law enforcement officer who has established a strong commitment to MADD's mission within the local community, or diligence in DWI arrests and an outstanding record of DWI arrests.

Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION:

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023 to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

MOTHERS AGAINST DRUNK DRIVING ‘TAKE THE WHEEL’ 2023 RECOGNITION AWARDS

OUTSTANDING LAW ENFORCEMENT AGENCY NOMINATION FORM (PLEASE TYPE)

Outstanding Law Enforcement Agency - Given to a law enforcement agency that is making a difference by going above and beyond in the area(s) of education, prevention, policy or enforcement and whose efforts are making an impact in reducing alcohol-related death and injury on Texas' roads.

Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION:

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023 to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

MOTHERS AGAINST DRUNK DRIVING ‘TAKE THE WHEEL’ 2023 RECOGNITION AWARDS POLICY SETTER NOMINATION FORM (PLEASE TYPE)

Policy Sette r- Group or agency that has shown dedication to working to save lives on local roadways by reducing impaired driving through efforts to set policy regarding DWI/DUI issues.

Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION:

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023 to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

MOTHERS AGAINST DRUNK DRIVING ‘ TAKE THE WHEEL ’ 2023 RECOGNITION AWARDS JUDICIARY SERVICE NOMINATION FORM (PLEASE TYPE)

Judiciary Service - Given to a judge that has shown dedication to working in the areas of DWI/DUI education, prevention, or innovation to reduce drunk and impaired driving.

Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION: (MINIMUM 1,000 CHARACTERS)

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023, to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

MOTHERS AGAINST DRUNK DRIVING ‘ TAKE THE WHEEL ’ 2023 RECOGNITION AWARDS

PROSECUTOR SERVICE NOMINATION FORM (PLEASE TYPE)

Prosecutor Service - Given to a prosecutor that has shown dedication working in the trenches to save lives on local roadways through their prosecution of drunk or impaired drivers.

Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION:

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023, to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

MOTHERS AGAINST DRUNK DRIVING ‘ TAKE THE WHEEL ’ 2023 RECOGNITION AWARDS LEADERSHIP HERO NOMINATION FORM (PLEASE TYPE)

Leadership Hero - Given to chiefs/commanders/captains/supervisors who have shown superior commitment to DWI enforcement by providing their departments and agencies with the resources, support, and trainings needed to reduce drunk and drugged driving.

Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION:

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023, to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

MOTHERS AGAINST DRUNK DRIVING ‘ TAKE THE WHEEL ’ 2023 RECOGNITION AWARDS UNSUNG HERO NOMINATION FORM (PLEASE TYPE)

Unsung Hero - Given to an individual or group, executive assistants/nurses/medical centers/group who go above and beyond the call of duty. This individual’s or group’s involvement must demonstrate a substantive contribution to Law Enforcement and/or DWI/DUI issues

Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION:

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023, to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

MOTHERS AGAINST DRUNK DRIVING ‘ TAKE THE WHEEL ’ 2023 RECOGNITION AWARDS

COMMUNITY PARTNER NOMINATION FORM

Community Partner - Given to a community partner who shows an outstanding dedication in areas of DWI/DUI education, prevention, or innovation to reduce underage driving and or impaired driving.

(PLEASE TYPE) Your Name (including rank): Your Organization: Your Street Address: Your City/State/Zip Code:

Your Daytime Phone: Your Email Address:

Nominee Name (including rank): Nominee Organization: Nominee Address: Nominee City/State/Zip Code:

Nominee Daytime Phone: Nominee Email Address:

REASON FOR NOMINATION:

Completed nomination forms must be emailed NO LATER THAN – April 3, 2023, to: Emma Dugas – State Program Manager, MADD North Texas emma.dugas@madd.org

Please call 214.637.0372 x 4828 if you have questions.

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