Instructions: The CAA School Safety Patrol Supervisor, school Principal, CAA training partner or bus driver should provide specific, detailed examples of the nominee’s qualifications in each of the following categories. Please keep these examples brief and in bullet-point format. The examples listed are guidelines only; please include examples that are relevant to the Patroller in their environment. Where applicable, include quantitative information — for example, helped increase student participation by 10%. Other supporting material may be included with the nomination, but at minimum four sections must be completed.

Leadership Qualifications (30%)

Examples may include ideas to improve the program at your school, positive communication skills, record keeping, attendance, punctuality, care and use of patrol equipment and leadership positions within the school/sports team/academic team/community group.

Safety Skills (30%)

Examples may include knowledge of patrol responsibilities, control of post, awareness of traffic/bus dangers, understanding/use of emergency procedures and efficiency in seeking adult guidance.

School Involvement/Community Volunteerism (40%)

Examples may include academic grades, school attendance, participation in school/after school programs and volunteering opportunities in the local community.

In Your Own Words

In the space below, please describe any events/situations that showcase why he/she is deserving of the CAA School Safety Patroller of the Year award. Be specific and provide context for each situation.

Attachments (Optional)

If you have any supporting material to be included with this nomination, such as letters of support from your school or other community stakeholders, please attach them below. You can select multiple files at one time. (Limited to 3 files with maximum 5 MB each in the following formats: png, jpeg, jpg, gif, csv, xls, doc, docx, xlsx, pdf, ppt, pptx.)