Online Form: Police Complaint or Commendation

Tompkins County Sheriff's Office

County Champion Nomination Form
Event Overview
Do you know someone who has done something extraordinary for someone else this year?

Do you know someone who has saved a life or responded courageously to a disaster?

Now is your chance to honor them. The Tompkins County Sheriff’s Office is seeking nominations for the monthly County Champion award.

Every day, ordinary people make extraordinary contributions by putting their needs aside to help others in our community. The Tompkins County Sheriff’s Office is honored to salute these unsung champions. Your champion might be a lifeguard who saved a drowning child, an ordinary citizen who performed CPR when a stranger collapsed at a shopping mall, or who saved a neighbor’s beloved pets from a fire, etc...
Nomination Guidelines
- Nominations should be submitted within one year of the event/incident.
- Nominees must live or work in Tompkins County.
- Nominees must be available to attend a Public Safety Committee meeting in the Tompkins County Legislative Chambers located at 121 E. Court St., Ithaca, NY 14850.
- For questions, please call 607-272-2444
If you would prefer to print and submit in person or via mail, please print off the following form:
Award Categories
Please select one:

Adult Good Samaritan (21 & over): Presented to an ordinary citizen who used life-saving skills tosave the life of another. Animal Rescue: Presented to the family of a pet who was instrumental in saving a life, or an ordinary citizen who was instrumental in saving an animal’s life. Education: Presented to an educator or layperson who used life-saving training to save the life of another in an educational setting. Fire Rescue: Presented to a volunteer firefighter whose life-saving actions exemplify the veryhighest standards of their calling. Good Neighbor: Presented to an ordinary citizen or professional rescuer involved in rescuing a person from a life-threatening situation. Military: Presented to a member of the Armed forces (active or retired, enlisted or officer) whose life-saving actions exemplify the very highest standards of their calling. Youth Good Samaritan (20 & under): Presented to an ordinary citizen who used life-saving skills to save the life of another. Community Service Award: This can be an organization, an individual(s) based on their community service. This does not have to be a specific act and will likely be number of hours and work benefiting an organization.
Name of Nominee:

First Name Middle Initial Last Name
Occupation:
Contact Phone Number:

Area Code Phone Number
D.O.B. :

Month Day Year
Date
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail of Nominee:

Nominated by:

First Name Middle Initial Last Name
Contact Phone Number:

Area Code Phone Number
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Relationship to Nominee:

Does your nominee know that they are being nominated?

Yes No
Upload nominated related photos or newspaper articles here.

Browse Files
not required Cancel of
Please state why you are nominating the candidate for a Real Heroes Award, such as where/when the heroic event occurred; whatactions and/or deeds make your nominee(s) a hero; what impact your nominee(s) made on your life, the lives of others, and thecommunity; the personal integrity of your nominee; how the nominee lives out the Red Cross mission.
Nominations should be submitted within one year of the event/incident.
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Tompkins County Sheriff's Office

Event Overview

Nomination Guidelines

Award Categories