THE MIKE BENOWSKI

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

NOMINATION FORM

The Virginia D.A.R.E. Association, Inc. will award the "Mike Bentowski D.A.R.E. Officer of the Year" to a candidate who is a member of the V.D.A. Inc., has been nominated by their department, and has demonstrated a high degree of commitment to the D.A.R.E. program in his/her schools, community and state.

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

Officer's Name:*

School System:*

Nominee's Agency:*

Number of semesters teaching DARE.:*

Year and location of D.O.T.:*

Nomination being submitted by:*

Your Title:*

Reason for nomination:*

* required Submit Cancel

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