Heroes of South Central Pennsylvania Hero Award Nomination Form The American Red Cross is looking for local heroes and is in need of your help! Do you know a person who has performed an extraordinary act of courage? Or someone who has dedicated countless hours to a special cause? Or even someone who went above and beyond in their normal duties to make a difference in the community? Every day ordinary people make extraordinary contributions by putting their needs aside to help others in our community. The American Red Cross is honored to salute these unsung heroes. Your hero might be a lifeguard who saved a drowning child, an ordinary citizen who performed CPR when a stranger collapsed at a shopping mall, or a person who saved a neighbor’s beloved pet from a fire. Nominate your hero today!
Award Categories 911 Dispatch: Presented to a 911 dispatcher who has helped to save or sustain another’s life, was unselfish and committed to going out of his/her way to perform the action
Fire Fighter: Presented to a professional or volunteer firefighter whose lifesaving action went above and beyond the call of duty
Adult Good Samaritan: Presented to an ordinary citizen above the age of 18, for an extraordinary act of heroism or courage
Law Enforcement: Presented to a law enforcement agent whose lifesaving actions went above and beyond the call of duty
Animal Rescue: Presented to an animal that saved the life of a human, an ordinary citizen who used lifesaving skills to save the life of an animal(s), or a professional involved in the care of animals
Medical Professional: Presented to a doctor, nurse or EMT whose lifesaving actions went above and beyond the call of duty
Aquatics: Presented to a lifeguard or ordinary citizen whose lifesaving action was able to prevent a serious water-related injury or drowning
Military: Presented to a member of the armed forces (active or retired) whose lifesaving action went above and beyond the call of duty (Heroic actions could have taken place elsewhere)
Community Impact: Presented to an individual who positively impacted/benefited many and has inspired others to make a difference or get involved
Youth Good Samaritan: Presented to an ordinary citizen under the age of 18, for an extraordinary act of heroism or courage
Nomination Guidelines • • • • •
Nomination deadline is August 28, 2015 Nominees must live in or have performed the heroic act in Adams, Franklin, Fulton or York Counties Heroic act must be ongoing or have been performed between August 18, 2014-August 18, 2015 Hero nominees, their nominators and/or the person who was saved must be available for videotaped interviews during September/October Nominees must be available to attend the Heroes Awards breakfast on November 19, 2015 in York
Nomination Form Nominee: Please fill out all information. Incomplete forms will not be considered. Mrs. Ms. Mr. Dr. Name Occupation Address City/State/Zip Phone (Day)
Email
Date of Birth
Phone (Evening)
Award Category Nominated by: Mrs. Ms. Mr. Dr. Name Address City/State/Zip Phone (Day)
Phone (Evening)
Email Relationship to nominee Does your nominee know that they are being nominated? Yes No Please state why you are nominating the candidate for a Heroes Award, including where/when the heroic event occurred; what actions and/or deeds make your nominee(s) a hero; what impact your nominee(s) made on your life, the life of others and the community; and contact information for witnesses who can verify the heroic act and character of your nominee. You may also attach any photos, newspaper articles or police reports.
Nominations are due August 28, 2015. Please return this form to: Mail: Ashley Martz Heroes of South Central PA American Red Cross, York office 724 South George Street York, PA 17401
Email or fax: Email to
[email protected] or fax to (717) 852-0104
34307
