To nominate your Brave Heart or Real Hero:

1. Thoroughly complete this form.

2. Write two to three paragraphs from the heart describing an act of courage or kindness and explain why your Brave Heart or Hero deserves to be recognized.

3. Attach up to four documents, such as lettes of support, news articles, or photographs (not required but recommended.)

Brave Heart or Real Hero Nominee

Nominee Name:*

Nominee Address:*

Nominee City:*

Nominee Zip Code:*

Nominee Phone:*

Nominee Place of Employment:*

Brave Heart or Real Hero Nominator

Nominator Name:*

Nominator Address:*

Nominator City:*

Nominator Zip Code:*

Nominator Phone:*

Email Address

Nominator Place of Employment:*

Award Categories

Choose a catagory for your nominee

Brave Heart - Law Enforcement
Brave Heart - Fire and Rescue
Brave Heart - Health Care
Brave Heart or Real Hero - Animal Rescue
Real Hero - Community
Real Hero - Red Cross Hero of the Year
Real Hero - Hero of a Lifetime
Real Hero - Family of Heroes
Real Hero - Adult Good Samaritan
Rea Hero - Youth Good Samaritan (under age 18)

Write two to three paragraphs from the heart describing an act of courage or kindness and explain why your Brave Heart or Hero deserves to be recognized.

Please type in field below

Attach up to four documents, such as lettes of support, news articles, or photographs (not required, but recommended).