Please note: Because the form needs to be completed in one session, you may wish to prepare answers before using the submission form. If you would like to mail in your submission form instead of sending it electronically, use this downloadable form.
Name, address, email and phone number of key contact person for city, county or local tribal government being nominated:
If different than key contact person above: Name, address, email and phone number of person nominating the city, county or local tribal government:
Changes to the built environment can be critical for safety improvements. Infrastructure improvements include accessible safe space for walking and biking, improved crossings and traffic calming. (maximum 3000 characters)
Policy changes can be an important part of changing the built environment, slowing traffic, limiting vehicle traffic on school streets, and encouraging active travel. (maximum 3000 characters)
How are you measuring success? Please describe your specific goals and how you measure them. Include any results, both quantitative and qualitative. Include any crash trend data that could be relevant such as serious and fatal injury rates for 0-17 year olds for the most recent five-year period for the location being nominated for the award. (maximum 2000 characters)