Excelsior Springs SAFE Community Champion Nomination Form
Excelsior Springs SAFE honors a Community Champion each month. Community Champions are outstanding adults in our community who, either through volunteer service or their careers, support and encourage Excelsior Springs youth to help them become caring, responsible and productive adults. Nominations open at the beginning of each month for an adult who exemplifies the characteristic or trait of the month. All nominations must be received by May 30 to be considered. All nominees receive a letter from Excelsior Springs SAFE notifying them of their nomination. Winners will be presented with an award from Excelsior Springs SAFE.

This month we will honor adults who foster a caring, encouraging environment at school.
Your Name:
Your Phone Number & Email Address:
Name of Nominee:
Nominee’s Place of Employment and/or Place of Volunteer Service:
Nominee’s business or home mailing address:
Please tell us how the nominee demonstrates the characteristic/trait of the month.
Why does the nominee deserve to be recognized as the Excelsior Springs SAFE Community Champion?
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