Northern Ohio Acts of Courage/Heroes Nomination
In which county does your nominee work or reside?
Summit
Portage
Medina
Trumbull
Mahoning
Columbiana
Cuyahoga
Hancock
Huron
Lake
Geauga
Lorain
Putnam
Seneca
Trumbull
Wyandot
Erie
Nominee's Name
*
First Name
Last Name
Nominee's Age
*
Nominee's Organization/Business:
Nominee's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nominee's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Nominee's Email
example@example.com
Parent/Guardian if under 18
First Name
Last Name
Date of heroic act
-
Month
-
Day
Year
Date
Location of heroic act
Please describe the heroic event. Provide as much detail as possible, including links to news stories (if applicable).
Your Information
Your Name
*
First Name
Last Name
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email
*
example@example.com
Relation to Nominee (if applicable)
Submit
Should be Empty: