Safe Sport Impact Award Form

IMPACT AWARD NOMINATION

PURPOSE
The purpose of the Safe Sport Impact Award is to recognize significant achievements by an individual or group who has contributed to the fulfillment of the Safe Sport mission to safeguard all members of USA Swimming from sexual, psychological, emotional and physical abuse.

Nominations can be submitted through July 31^st, 2020. All nominations will then be reviewed, and a recipient will be selected before the United States Aquatic Sports Convention. The recipient will be honored at Convention.

SAFE SPORT MISSION STATEMENT
USA Swimming is committed to safeguarding the well-being of all of its members, with the welfare of its athlete members as the top priority.

PAST RECIPIENTS
2014 Bob Kizer (WT) 2015 Paul Stockett (MA) 2016 Paul Stauder (IN) 2017 John Morse (MV) 2018 Ceci Christy (GA) 2019 John Ingram (UN)

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NOMINATOR

First Name *

Last Name *

Street Address

Address Line 2

City

State

Zip Code

Phone Number *

Email Address *

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NOMINEE

First Name *

Last Name *

Street Address

Address Line 2

City

State

Zip Code

Phone Number *

Email Address *

Is the Nominee a member of USA Swimming? *

Yes

No

If yes, what is the Nominee's LSC?

If the Nominee is not a member of USA Swimming, what is the Nominee's relationship to USA Swimming?

NOMINEE'S QUALIFICATIONS

1. What are the Nominee's contributions which promote the mission of Safe Sport? *

2. Why or how are the Nominee's contributions impressive? *