Form Center

2. Joe Bergeron Community Service Award

4. The Maplewood Police Department is seeking nominations for the annual Sergeant Joe Bergeron Community Service Award. This award was created in collaboration with the Bergeron family to honor his legacy through the community service that he provided throughout his career. Please submit nominations no later than 4:00 p.m. on Friday, March 31, 2023. The award will be presented at the Maplewood Police Memorial Service in memory of Joe Bergeron on a date to be determined.

5. 
7. .
8. Community Service Award Policy
   Criteria to be considered
10. Name of Individual for whom award is requested
11. Current Date
    Current Date
13. Is this individual a Department Employee?

    1. Yes
    2. No
    3. I don't know
14. Officer Badge #
16. Narrative
    Please completely describe the actions specific to community contributions in terms of service which you feel justify recongition.
18. Please attach additional documentation or picture
22. Name of Person Submitting Nomination
23. Phone Number
25. Street Number
26. Street Name
27. Street Type
29. Apt or Unit #
30. City
31. State
32. Zip
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field