Washington Child Passenger Safety Award Nomination

This awards program will acknowledge the exemplary contributions across the state who have made significant efforts to prevent unintentional child injuries in Washington due to traffic collisions. 

Nominations will be accepted through February 15, 2025. We are planning to recognize selected recipients at the Washington Child Passenger Safety Summit on March 26, 2025 at UW-Tacoma.

You may nominate an individual, team, business, or community partner. 

Sign in to Google to save your progress. Learn more
Name of individual, team, business, or community partner you are nominating.
Include their contact information (email, phone).
 *
Reason for nomination.
(include as much detail as possible ie; seats checked, families reached, resources distributed, community impact, innovation, display of commitment, etc.)
 *
Contact information of person submitting nomination.  Include your contact information (email, phone). *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms