2021 L. Anthony Sutin 

Award for Innovative 

Law Enforcement and 

Community Partnerships Nomination Form 

This nomination form plus a narrative are required to be 

considered for this award; letters of support are optional. The 

narrative should be a Microsoft Word or PDF fle of no longer than 

fve pages in 12-point Times New Roman. 

All nomination materials must be sent via email to 

SutinAward@usdoj.gov (ATTN: LaToshia Butler) by 

Wednesday, December 8, at 5:00 p.m. ET. 

Fields marked with an asterisk (*) are mandatory. 

Name of Law Enforcement Offcer Nominee 

*(Last, First, Middle) 

*Title 

*Agency 

Street address 

City/State 

Postal code 

*Telephone 

Fax 

*Email 

Agency’s website (if applicable) 

Name of Community Partner Nominee 

*(Last, First, Middle) 

*Title 

*Organization 

Street address 

City/State 

Postal code 

*Telephone 

Fax 

*Email 

Organization’s website (if applicable) 

Continued ▶
Name of Nominator 

*(Last, First, Middle)

*Title 

*Agency/Organization (if applicable) 

Street address

City/State 

Postal code 

*Telephone 

*Email 

Please be advised that the narrative and any pertinent details 

may be published in a COPS Offce publication highlighting 

nominees. 

*Signature of NOMINATOR 

Date 

Privacy Information 

Please note the following: 

• Before sending us names, phone numbers or email addresses, 

please read our Privacy Policy and the below Privacy Act 

Statement for details about how we handle personal information 

that you voluntarily provide. 

• This form should not be used for service of official, case-related, or 

legal documents because it is not monitored for such submissions 

or for other time-sensitive communications. 

• Please do not include any personally identifiable information about 

victims or third parties in your submission. 

Privacy Act Statement 

Section (e)(3) of the Privacy Act of 1974, codified at 5 U.S.C. 552(a), 

requires that the U.S. Department of Justice inform users of its 

authority to request personal information, how the information will be 

used, and the effects of not providing the requested information. 

Authority. The Violent Crime Control and Law Enforcement Act of 

1994, Pub. L. No. 103–322, 108 Stat. 1796 (1994) authorizes 

collection of this information. 

Purpose. This information will be used to select law enforcement 

officers and community members for the 2021 L. Anthony Sutin 

Award for Imaginative Law Enforcement and Community Partnerships. 

Routine use. The information collected will be used by COPS Office 

personnel, who will assist with selecting and notifying the successful 

candidates for the 2021 L. Anthony Sutin Award for Imaginative Law 

Enforcement and Community Partnerships. 

Disclosures. Disclosure of names and contact information, including 

email addresses and phone numbers, by individuals to the U.S. 

Department of Justice is voluntary. However, if the requested 

information is not provided, the COPS Office will be unable to 

consider the nomination. 

U.S. Department of Justice 

Office of Community Oriented Policing Services 

145 N Street NE 

Washington, DC 20530 

https://cops.usdoj.gov 

e051605756