THE Gary B. Payne

D.A.R.E. ADMINISTRATOR OF THE YEAR AWARD

NOMINATION FORM

The Virginia D.A.R.E. Association, Inc. will award the "Gary B. Payne D.A.R.E. Administrator of the Year" to an law enforcement administrator who has been nominated by their department and has demonstrated a high degree of commitment to the D.A.R.E. program in his/her community and state.

Please submit the name of the D.A.R.E. Administrator who you feel is worthy of this award and detailed information as to why you feel this candidate should be chosen.

Adminstrator's Name:*

Administrator's Agency:*

Your Name:*

Your Title:*

Date:*

Reason for nomination:*

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