2013 Clinton and Highland County American Red Cross Heroes Awards Nomination Form

2013 Clinton and Highland County American Red Cross Heroes Awards Nomination Form

Guidelines: Nominee(s) must live or work in Clinton or Highland County and the heroic act must have taken place on or between December 31, 2011 and December 31, 2012. Self-nominations are NOT permitted. All nominations will be subject to further verification and validation. All nominees will be considered and finalists will be determined for each category. All nomination forms must be completed before submitting. Recipients of each award will be announced at the Heroes Awards Breakfast.

Nominee Information

First & Last Name(s) ______

Email: ______

Employer: ______Title/Occupation: ______

Mailing address: ______

City: ______State: ______Zip: ______

Home Phone: ______Cell Phone: ______Alt: ______

Is nominee able to attend the Breakfast in March? ______Award Category: ______

Nominator Information

First & Last Name(s): ______

Email: ______

Employer: ______Title/Occupation: ______

Mailing Address: ______

City: ______State: ______Zip: ______

Home Phone: ______Cell Phone: ______Alt: ______

Is it possible for you to attend the Breakfast in March? ______

Nomination forms should be delivered, faxed, mailed, or emailed to the American Red Cross Office by Monday, January 7, 2013.Attn: Kelley Robbins, 2013 Heroes Breakfast Nominations, American Red Cross, 50 South Mulberry Street, Wilmington, Ohio, or fax 937-382-0970. Please call or email a notification if faxed to confirm receipt. Please call Kelley Robbins at 937-382-0083 or email ith any questions or for additional information.

Please include any additional details you feel would be helpful to our Heroes Cabinet on the back of form or on additional paper.

Questions

What impact, heroic action, or deed has the nominee or group made for another person, animal, group, organization, or the community that makes you feel they should be the recipient of a Heroes Award?Please cite one or more examples to support your nomination.

Is there a specific time frame or date action(s) occurred? Please cite date(s) if possible.

If possible, please cite one or two references that we may contact to confirm the information you have provided. Please include name, phone number(s), email address, and mailing address. Is there a specific time of day that is best to contact the reference?

Please include or cite any newspaper articles or dates published about the nominee’s actions, if any exist.