Higgins & Langley Memorial Awards in Swiftwater Rescue 2005 NOMINATION FORM COVER SHEET AND CHECK LIST:

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Higgins & Langley Memorial Awards in Swiftwater Rescue 2005 NOMINATION FORM COVER SHEET AND CHECK LIST: Dear Applicant: Please remember that the nomination is your responsibility. That means filling out the application completely and supplying as much detail as possible concerning all aspects of the nomination. If you have video, newspaper articles, letters, reports or other support material, please send copies, not originals. We need the following basic information to consider an application: ORGANIZATION OVERVIEW: Name of Agency/Organization: Agency Mailing Address: Name of person submitting nomination: Position or relationship: Phone number: FAX: Email address: NOMINATION FORM CHECK-LIST: 1) Have you included a detailed statement supporting this nomination, including background information, swiftwater/flood rescue training documentation, incident reports, and/or other appropriate documentation? 2) Have you included copies of relevant newspaper or magazine articles concerning this agency, team, individual, or incident? 3) Have you included video or other media materials, if available? 4) Have you included letters of support for this award from appropriate professional organizations and individuals? 5) For TEAM nominations: have you included a complete list of names, properly spelled, ready to be printed on certificates?

Higgins & Langley Memorial Awards in Swiftwater Rescue 2005 NOMINATION FORM, page two cover sheet 6) Have you included SEVEN COPIES total of the COMPLETE WRITTEN NOMINATION FORM, including support documentation? Please ensure that every detail of the nomination as it applies to the individual(s) named is clearly depicted for the committee to evaluate the application. Providing additional letters of support, especially from other individuals or organizations is helpful. It is your responsibility to provide enough detail so that the committee can comfortably make a decision concerning this nomination. Simply saying that someone is a great guy who deserves an award is not enough. What exactly has the nominee done and why is this exceptional? Certification of Authenticity The Higgins & Langley Awards offer an opportunity to honor personnel in an appropriate manner, based in part on self-regulated. The integrity of the program requires honesty and truthfulness of the application process and any falsified application threatens the validity of the awards program. It is imperative for all participants to accurately report incidents as they happened and not embellish facts in the hope of a commendation being awarded. It is of no advantage for any emergency service to misrepresent an incident for any reason, so we ask you to sign the following statement. I understand and support the concept of a self regulating honor system for the benefit of all emergency services. In signing, I swear and certify that this nomination is accurate, true and correct. I have not altered any detail(s) of the application in any way, and understand that doing so will invalidate any commendation awarded and/or issued. In certifying that this statement is accurate and true, I also agree to pay any costs incurred by the awards committee that arise from recovering an invalidated commendation due to inaccurate or false information knowingly supplied by me in this application process. This application is a true representation of an incident, program, rescue team, or individual worthy of consideration. I have read the above statements, agree with them and sign this application willingly. Certified this day by DAY/MONTH/YEAR PRINT APPLICANT S FULL LEGAL NAME FAILURE TO INCLUDE ALL REQUIRED INFORMATION WILL AUTOMATICALLY DISQUALIFY NOMINATION

Higgins & Langley Memorial Awards in Swiftwater Rescue 2005 NOMINATION FORM, page three cover sheet COMPLETED NOMINATION FORMS MUST BE POSTMARKED NO LATER THAN APRIL 18, 2005 and all seven copies MAILED * TO: Mr. Paul McMinn, Chairman Higgins and Langley Awards Committee c/o South Bend Parks & Recreation Dept. 321 East Walter St. South Bend, IN 46614 Tel: 574-299-4765 * Due to the amount of written documentation and support materials required, nominations cannot be submitted electronically.

HIGGINS AND LANGLEY MEMORIAL AWARDS FOR OUTSTANDING ACHIEVEMENT IN SWIFTWATER RESCUE BACKGROUND INFORMATION: The Higgins and Langley Memorial Awards honor outstanding achievement in the technical rescue discipline of swiftwater and flood rescue. They are not heroism awards, but rather recognize preparedness, teamwork, and a job well done, often under extreme conditions, where training is vital to the success of rescue missions, as well as the safety of rescue personnel. The awards were established in 1993 by members of the Swiftwater Rescue Committee of the National Association for Search and Rescue (NASAR) in honor of Earl Higgins, a writer and filmmaker, who lost his life in 1980 while rescuing a child who was swept down the flood-swollen Los Angeles River, and Jeffrey Langley, a Los Angeles County Fire Department firefighter-paramedic and pioneer in swiftwater rescue, who lost his life in a helicopter incident in 1993. There are several award categories, including the highest award presented: the Higgins and Langley Award for Outstanding Achievement in the Field of Swiftwater Rescue. The Program Development Award honors those who have developed and implemented stellar swiftwater rescue programs. The International Award honors international teamwork and individual accomplishments. Team, Incident, and Special Commendation Awards recognize individual contributions, as well as teamwork. And on occasion, a special Lifetime Achievement Award is presented. Flooding is the leading cause of weather-related death nationwide. Rescuers who lack proper swiftwater/flood rescue training and equipment are also at risk of serious injury and loss of life. Every year, would-be rescuers, both citizens and professionals, die in swiftwater incidents. Although improvements in response capability are being made in many public safety agencies, others remain inadequately prepared to perform safe and effective swiftwater and flood rescues. Higgins and Langley Memorial Awards have increased awareness about the need for specialized swiftwater and flood rescue training. As a result, worldwide training certifications have increased and agencies have been inspired to develop viable water rescue programs, both for the protection of the public, as well as the safety of their personnel.

Page Two: Higgins and Langley Memorial Awards BACKGROUND SPONSORSHIP: Higgins and Langley Memorial Awards are sponsored by NASAR and private donors through the non-profit 501(c)3 Higgins & Langley Memorial and Education Fund. Contributions are solicited to ensure the continuation of this award. AWARDS: Each year recipients of Higgins & Langley Memorial Awards are acknowledged for their contributions to the swiftwater rescue community. Recipients of the premier Higgins & Langley Memorial Award are presented with an engraved plaque and custom designed and engraved medal for the team, individual, or agency, as well as certificates for individual team members. Recipients of the Program Development Award and Lifetime Achievement Award are presented with a special engraved plaque and medal. The remaining awards receive agency medals and individual certificates for team members. All awards, regardless of type, are issued as determined by the committee. There is no obligation on behalf of the committee to award any or all types of awards in any given calendar year. AWARD CATEGORIES (SELECT ONE): The Higgins & Langley Memorial Award for Outstanding Achievement in the Field of Swiftwater Rescue The Higgins & Langley Memorial Award is the premier internationally-recognized award for excellence in swiftwater and flood rescue. It signifies an intense dedication to the field and a genuine desire to benefit the larger community responsible for the service. Only one Higgins & Langley Memorial Award is awarded in any calendar year. Lifetime Achievement Award The Lifetime Achievement Award is reserved for those few individuals who make a significant, lasting and continuous impact in the field of swiftwater rescue. Consequently, Lifetime Achievement Awards are rarely awarded. Program Development Award The Program Development Award recognizes agencies that make a significant commitment to swiftwater and flood rescue programs in their area. This award profiles the education, training and resources to develop a successful swiftwater and flood rescue program.

Page Three: Higgins and Langley Memorial Awards BACKGROUND International Award The International Award recognizes individuals or teams outside the United States that merit consideration for contributions or specific incidents in the field of swiftwater/flood rescue. Incident Award Occasionally, a specific Incident is recognized that clearly demonstrates outstanding skill and preparedness in a swiftwater rescue. Team Award Recognizing the importance of team dynamics in the field of Swiftwater Rescue, a Team Award is considered in cases of outstanding, group dynamics or achievement. Special Commendation Award The Special Commendation Award recognizes the breadth of possible contribution in the field of swiftwater rescue. Awards of this type can be for media contribution, strategic planning, individual heroism or esprit de corps. AWARDS PRESENTATION CEREMONIES: The Higgins and Langley Memorial Awards are presented during the annual National Association for Search and Rescue Conference with special ceremonies as needed at the local level. Due to budget restrictions the awards committee cannot offset the cost of transportation of recipients to the awards ceremony. Please NOTE: the committee reserves the right to recommend nominees for categories other than those for which they were initially submitted unless requested not to do so. * * *

Higgins and Langley Memorial Awards for Outstanding Achievement in Swiftwater Rescue NOMINATION FORM I am proud to submit a nomination for the following category (select ONE): Higgins & Langley Memorial Award Lifetime Achievement Award Program Development Award International Award Incident Award Team Award Special Commendation Award IMPORTANT: For team nominations include email addresses and phone numbers for ALL nominees (use a separate page if necessary). FULL NAME: Depending on the nomination, this may be an individual or a team name CONTACT: ( ) Name Phone Number ADDRESS: Address City State Zip EMAIL: Individual contact or agency

Page Two: Higgins and Langley Memorial Awards NOMINATION FORM Please supply the following information/documentation: 1) NAME OF NOMINEE, TEAM MEMBERS, AGENCY, or those responsible for this swiftwater flood rescue program. NOTE: Spell names correctly and include middle initials. Please IDENTIFY TEAM LEADERS, PROGRAM COORDINATOR(s) or OTHERS who may deserve special recognition. 2) BACKGROUND INFORMATION: i.e. when was the swiftwater/flood rescue program developed, did any noteworthy incident(s) prompt development of the program, how is the program funded (donation, public funds, etc.), is it a multi-agency effort, which agency or agencies are charged with directing the program, etc.? Include TRAINING and CERTIFICATION REQUIREMENTS, and please indicate whether swiftwater-flood rescue team(s) are full-time sworn personnel, volunteer or a combination. 3) Provide information essential to the nomination. Describe the Incident (for Incident or Special Commendations); or provide Incident report(s) (or synopses) outlining team response (for Team Awards); or provide the history of Program Development. In cases of actual incidents, please include dates, times, names and status of victims (where known), and whether or not rescues took place during officially declared disasters. 4) Include copies of newspaper and/or television/radio news reports. Where available please note availability of video of team activities, which might be accessed by awards committee. 5) Why does this individual, swiftwater-flood rescue team or program deserve international recognition?

Page Three: Higgins and Langley Memorial Awards NOMINATION FORM NOTE: Failure to provide all documentation may result in delay or disqualification of the nomination. PLEASE BE SURE ALL INFORMATION IS ACCURATE, COMPLETE AND APPLICABLE TO THE TYPE OF AWARD. Always spell names correctly and include middle initials. Any cost for reprinting certificates or other printed materials due to spelling errors on submitted nomination forms will be covered by nominating agencies or award recipients. THANK YOU FOR YOUR SUBMISSION. Mr. Paul McMinn, Chairman Higgins and Langley Awards Committee c/o South Bend Parks & Recreation Dept. 321 East Walter St. South Bend, IN 46614 Tel: 574-299-4765 The Higgins and Langley Memorial and Education Fund 501(c)3 non-profit http://www.higginslangley.org