Sexual Assault Awareness Month Award Nomination Form



Recognize individuals or organizations that demonstrate an extraordinary commitment and service to victims of sexual violence. This award may also acknowledge individuals or organizations that improved the accessibility or appropriateness of systems for victims of sexual violence.


Nominees will be judged on their overall contributions to victims of sexual violence and the positive impact (both short-term and long-term) that their efforts have made toward a society in which sexual violence no longer exists.

Nomination Period

Nominations will be accepted at the offices of the Utah Coalition Against Sexual Assault by fax and email, up until and including Tuesday April 4th, 2017.


1. Nominators must complete the nomination form in its entirety and provide all supporting documentation.

2. All nomination forms and supporting documentation must be received at the offices of the Utah Coalition Against Sexual Assault by mail at 284 West 400 North Suite 103 Salt Lake City, Utah 84103; by fax at 801-746-2929; or by email at [email protected] no later than 5pm on April 4th, 2017.

3. Nominators may nominate themselves or their agency.


Individuals from UCASA and a committee of other community and/or board members will review all nomination forms and supporting documentation and select up to five recipients. The individuals selected will be honored and presented with their awards at our Sexual Assault Awareness Month Awards Party on April 28th, 2017. Details for the party are available here. 

This survey has no published questions.