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 the 20th of the month 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.

November: Adult Role Models
This month, we are seeking nominations of community members who serve as adult role models to youth. Adult role models demonstrate positive, responsible behavior. They have high standards for themselves and adhere to them even when it's not easy.
Your Name:
Your answer
Your Phone Number & Email Address:
Your answer
Name of Nominee:
Your answer
Nominee’s Place of Employment and/or Place of Volunteer Service:
Your answer
Nominee’s business or home mailing address:
Your answer
Please tell us how the nominee demonstrates the characteristic/trait of the month.
Your answer
Why does the nominee deserve to be recognized as the Excelsior Springs SAFE Community Champion?
Your answer
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