Brave Hearts Nomination Form for 2011

Nominations are due by November 30, 2010.

Please read through the award criteria, requirements and choose the category that best fits your candidate, and then complete the form.

Name    
Address 
City      State    Zip 
Phone(day)      Phone(evening)  
Email   
Place of employment  
Title   
Relationship to you

Name    
Address 
City      State    Zip 
Phone(day)      Phone(evening)  
Email   
Place of employment  
Title   
How did you hear about Brave Hearts?

In 300 words or less, describe the act of courage or
kindness which prompted you to nominate the individual
and explain why your hero deserves recognition.



                      

How to Nominate Your Brave Heart

Please read through the award criteria, requirements and choose the category that best fits your candidate, and then complete the form. The specific act must have occurred in the year from December 1, 2009 to November 30, 2010. All acts will be verified.

Award Category Criteria

Community Safety & Security

• The nominee is a lay person who used personal knowledge and/or skills to come to the aid of another person or persons.
• The nominee either used lifesaving skills such as CPR, water rescue or first aid to assist someone in crisis or reached out to help another person providing a safe and secure environment to ensure the person’s well-being.

Emergency Response

• The nominee is a professional/volunteer rescuer serving as a law enforcement official, a fire fighter, a first responder, or in the medical/healthcare field.
• The nominee exhibited heroism in his/her response to an emergency on or off-duty or is involved in an ongoing situation in which a commitment is made to the community through an act(s) of kindness, courage or unselfishness in response to an identified need.

Corporate

• The nominee is a business which has made an impact in ensuring the health, safety and well-being of our community through:
  • Philanthropic actions, contributions or activities,
  • Employee volunteer activities and involvement in the community or
  • Other community partnerships serving the health and safety of the community.

Health Care

• The nominee is a professional emergency medical technician, nurse, doctor or other health care worker and could be on or off-duty at the time of the heroic act.
• The nominee exhibited heroism through a sacrifice of time, money, or personal safety in his/her health care role. Or, the nominee is involved in an ongoing situation in which a commitment is made to the community through an act(s) of kindness, courage or unselfishness in response to an identified need or improvement in another's quality of life.

Youth

• The nominee was 18 years old or younger at the time of the act.
• The nominee stepped forward in a time of crisis to help another person or worked toward the betterment of our community by taking action and serving as an example to other youth.
• If a parent is nominating a child there needs to be another nomination form received from someone other than family.

Award Requirements

1. The act of courage or kindness can be ongoing or have occurred at a particular time.
2. Either the nominee must be from or the heroic acts of courage or kindness or both must have occurred in one of the following counties: Dodge, Kenosha, Milwaukee, Ozaukee, Racine, Walworth or Waukesha.
3. The event or action needs to have/had local impact.
4. If someone is nominated by a family member, an additional nomination from a person other than a family member is needed.
5. Nominees selected for recognition must be present at the mid to late March Brave Hearts event. (If the nominee died during the rescue, then a family member may be present at the event.)
6. Additional consideration may be afforded for any Red Cross involvement such as trainings, partnerships, collaborations or volunteering.
7. Submit your entry by using one of the following methods:
   • FAX this form to: 414-342-7802
   • EMAIL the information on this form to: bravehearts@redcrossinsewis.org
   • ON-LINE at www.redcrosssewis.org/bravehearts.html
   • MAIL this completed nomination form and any supporting documents to:
     • Attn: Gina Trimboli
       American Red Cross Brave Hearts
       2600 W. Wisconsin Avenue
       Milwaukee, WI 53233

For more information about the 2011 Brave Hearts event contact Gina Trimboli at 414-345-8689 or email bravehearts@redcrossinsewis.org.

Nomination forms must be received by November 30, 2010.