Southern Tier Real Heroes Nomination
Every now and then, an unselfish and extraordinary action on behalf of a neighbor, a coworker, or even a stranger can change another person’s destiny or make an impact on the community. In that moment, ordinary people become Real Heroes. The American Red Cross is honored to salute these unsung heroes.
Nominator Name
First Name
Last Name
Relationship to Nominee
Nominator Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nominator Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Nominator Email
*
example@example.com
Nominee Information
Hero Name(s)
*
Hero Occupation(s)
Hero/Heroes' Contact Information (Address, Phone Number, Email Address)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Award Categories (select all that apply)
Animal Rescue
Blood Donor
Education
Fire Rescue
Good Neighbor
Good Samaritan - Adult (21+)
Good Samaritan - Youth (20 & under)
Law Enforcement
Lifeline
Medical
Military
Workplace Safety
Please state why you are nominating the candidate for a Real Heroes Award, such as 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 lives of others, and the community; the personal integrity of your nominee; how the nominee lives out the Red Cross mission. Details of the nomination story:
(attach a file if you need more space for your story)
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Date/Timeframe of Occurrence
-
Month
-
Day
Year
Date
Place of Occurrence
Does your nominee know that they are being nominated?
Please Select
Yes
No
If applicable, do you know the name of the person(s) saved during this heroic act, please include their name and contact information, if known, here:
How did you hear about the Real Heroes Event?
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