Wisconsin Service to Prevention Honors
2012 Nomination Form

The Wisconsin Service to Prevention Honors recognize individuals and groups who have made significant contributions to creating and reinforcing conditions at the local, regional, or state level that promote healthy behaviors and lifestyles.

Nominations must be received by 12:00pm (Midnight) on Tuesday, May 22, 2012. 
Nominations received May 23 or later will not be considered.
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An individual or group will be honored in each of the following categories:

Outstanding Elected Official:  An individual working at any level of government, who has contributed significantly to creating and reinforcing conditions at the local, regional, or state level that promote healthy behaviors and lifestyles.

Leadership in Prevention: An individual who has made an outstanding contribution through professional service to advancing the fields of health promotion and prevention in Wisconsin.

Outstanding Law Enforcement Partner:  A law enforcement officer or department for outstanding service to community coalitions, partnerships, or other collaborative efforts that promote healthy behaviors and lifestyles.

Outstanding Prevention Volunteer – Adult:  An adult volunteer who has made significant contributions to local, regional, or state efforts aimed at creating and reinforcing conditions that promote healthy behaviors and lifestyles.  This award recognizes service outside of employment, but may be given to someone who works in the prevention field in recognition of their contributions as a volunteer in community prevention initiatives.

Outstanding Prevention Volunteer – Youth:  A youth volunteer (under age 21), who has made significant contributions to local, regional, or state efforts aimed at creating and reinforcing conditions that promote healthy behaviors and lifestyles.

Outstanding Prevention Coalition:  A coalition or partnership that has made significant contributions to creating and reinforcing conditions at the local, regional, or state level that promote healthy behaviors and lifestyles.

Lifetime Achievement in Prevention:  To recognize an individual who has made exceptional contributions to health promotion and prevention over a number of years. This individual is an innovative thinker, whose work has advanced prevention and wellness efforts in Wisconsin, and is viewed by his or her peers as an integral part of Wisconsin’s wellness and prevention efforts.

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Recipients will be notified of their selection and invited to attend the Wisconsin Service to Prevention Honors Luncheon during the 2012 Wisconsin State Prevention Conference. The Luncheon is being held on Tuesday, June 12, from 12:15 - 1:15 pm, at the Kalahari Resort Hotel in Wisconsin Dells.