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Webster Police Department Webster School District Webster Health & Education Network

MAKING A DIFFERENCE

Nomination Form

Making a Difference: To foster growth in our youth & create positive interaction among students and community members.

WEBSTER POLICE DEPARTMENT

MAKING A DIFFERENCE AWARD

Each year the Webster Police Department will honor Webster High School students who distinguish themselves through their exemplary behavior. Selections will be conducted through a review process conducted by school staff.  If you are aware of a student whose positive accomplishments, actions, or efforts deserve recognition, please complete this form and send it to:

 

Officer Peter Scorsone
Webster Police Department
1000 Ridge Road
Webster, NY 14580
585-872-1216 x233
Fax: 585-872-7010

 

High school student nomination forms are due February 1st , while middle and elementary school students are due May 1st of each year. 

High school student selections will be honored at the Webster Police 1000 Club Annual Awards Dinner in March.  Junior high and elementary students will be recognized at a "Making A Difference" ceremony each spring. 

 

       

Name of Student:___________________________ Parent’s Name:____________________________________

                                    (Please print legibly)

Students Address:_____________________________________ Telephone #: ___________________________

                                    (Include Town, Zip)

Age/Grade in High School:________ Name of School: ______________________________________________

 

Your Name:_____________________________________ Telephone #: _______________________________

  

Your Address:______________________________ Relationship to Nominee:___________________________

Explain why you are nominating the student: Please include instances of Role Modeling, Good Samaritan, Community Service (not related to course credit), Recognition of Academic Efforts (not based on highest GPA), Positive Contributions to School Environment, Exemplary Action that positively benefits the Webster Community and Positive Peer Influence (Use back of this form or include separate synopsis).

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