Making an Impact Nomination Form
It’s time to thank and recognize those traffic safety and substance abuse prevention champions who are making an impact in Wyoming.

The Traffic Safety and Substance Abuse Prevention Awards will be presented in conjunction with the biannual Wyoming Conference on Impaired Driving held May 8-9, 2019 in Laramie, WY at the Hilton Garden Inn. A banquet will be hosted on May 8th to honor those in Wyoming who go above and beyond to make Wyoming a safer, healthier place to live, work and play.

Please consider nominating someone known to have made an impact within their community, the State, or within their professional world to make Wyoming a safer, healthier place to work, live, and play. These individuals or organizations are making an impact in law enforcement, prevention, prosecution, judicial, legislative, education, and/or community service efforts. Nominations should be made for people who make an impact in traffic safety (impaired driving, distracted driving, occupant protection) or prevention (alcohol, tobacco, or other drugs) efforts. Individuals and organizations may be nominated by any person who is familiar with the efforts and activities of the nominee.

Please provide all information needed for the Selection Committee to evaluation this nomination by April 15th, 2019
Email address *
Your name *
Your answer
Name of Nominee *
Your answer
Organization nominee is associated with *
Your answer
Why is this person or agency deserving of recognition? How have they made an impact? Provide specific details and examples of traffic safety or prevention activities and elaborate as much as possible (e.g. enforcement efforts, education involvement, community involvement, initiatives, etc.) *
Your answer
Why is it important? *
Your answer
Who are you to the nominee? (Can we tell them who nominated them?) *
Your answer
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