People of Courage Awards 2018 -- Nomination Form
RequiredRequired Question(s)
1.
Please enter your contact information

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First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

Please enter your nominee's contact information (name/phone/email, etc.): 

 

350 characters left.
Required 3.

Does the nominee live/work in the Central Massachusetts area?

yes
no
Required 4.

Does the nominee show demonstrated commitment to serving as a role model for LGBTQ youth/adults or other marginalized group, as applicable to the award?

yes
no
Required 5.

Does the nominee show demonstrated commitment advocating for equal rights and social justice for all? 

yes
no
Required 6.

Does the nominee show distinguished contribution to LGBTQ youth/adults or other marginalized groups in Central MA, as applicable to the award?

yes
no
Required 7.

Does the nominee agree to be recognized by Safe Homes for his/her contributions and this achievement at public events and in the media?

yes
no
Required 8.

Award Categories (please check only one)

Youth/Young Adult Award
Volunteer Award
Public Service Award
Corporate Award
Social Justice Advocacy and Action Award
Media Award
Create Your Own Category
Required 9.

Additional Information about Nominee:

 

1000 characters left.