| Guidelines: Nominee(s) must live or work in Cook, DuPage, Kane, Kendall, Lake, McHenry or Will counties and the heroic act must have taken place on or between Jan. 1, and Dec. 31, 2010. Self-nominations are NOT permitted. All nominations will be subject to further verificiation and validation. Winners will be notified by Spring 2011. |
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 Nominator Information |
First Name
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Last Name
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Birthdate
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Occupation
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Address Type
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Address
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City
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State
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Zip Code
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Preferred Phone Type
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Preferred Phone Number
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Alternate Phone Number
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Preferred Email
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Are you available to attend this event?
| Yes
No |
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Nominee(s) Information |
First Name
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Last Name
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Birthdate
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Occupation
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Ethnicity
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Address Type
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Address
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City
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State
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Zip Code
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Daytime Phone
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Evening Phone
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Email
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| If you are nominating additional people for this act, please list their names below. |
Other Nominees (First & Last Names)
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Award Category - Please select one.
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What is your relationship to the nominee(s)?
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| In the space provided below, please describe the heroic actions and/or deeds of your nominee(s) in 300 words or less. |
| Please answer the following questions in your essay.
1. When/where did the heroic act occur?
2. What actions and/or deeds make your nominee(s) a hero?
3. How would you describe the personal integrity of your nominee(s)?
4. What impact has your nominee(s) made on your life, the life of others and/or the community?
5. The mission of the Red Cross is to help others prevent, prepare for, and respond to disasters. How does the nominee(s) live out the Red Cross mission? |
Essay
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Will your nominee(s) be able to attend this event?
| Yes
No |
| Please include contact information for at least one witness who can verify the heroic act and character of your nominee. |
Witness 1 First & Last Name
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Witness 1 Preferred Phone Number
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Witness 2 First & Last Name
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Witness 2 Preferred Phone Number
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| The winners and their nominators will be interviewed for a video to be shown at the 2011 Heroes Breakfast. Filming will occur during business hours in March 2011. |
Will you be available to participate in filming?
| Yes
No |
Will your nominee(s) be available to participate in filming?
| Yes
No |
How did you hear about the 2011 Heroes Breakfast?
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If you selected "Other," please specify:
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| To submit supporting materials (news articles, police reports, photographs, etc.), please email chicagofd@usa.redcross.org or mail to The American Red Cross of Greater Chicago, Attn: 2010 Heroes Breakfast, 2200 W. Harrison Street, Chicago, IL 60612. *Note: We will be unable to return submitted materials. |
| Please visit www.chicagoredcross.org/heroes or call (312) 729-6138 for more information. |
