2010 Salute to Courage Nomination Form

Each September, the New Castle Community YMCA honors a community member who has demonstrated great courage in recovery from accident, illness or injury, in living with a disability, or through an act of heroism.

Please use this form to nominate someone you know - a friend, neighbor, patient or family member - who exemplifies Courage. You may nominate more than one person, but submit a separate form for each. You may also nominate a person who has been nominated previously but who was not an award recipient.

Nominations must be received by July 9, 2010

Name of Nominee

Name:

Address:

Phone:

Nominator Information

Name:

Address:

Phone:

Email:

Relationship to Nominee:

Nomination Support Information

Please describe the nature of the disability, accident, illness, injury or act of heroism and how the candidate demonstrates courage.
How has the nominee approached recovery and rebuilt his/her life? Stress the nominee's accomplishments, especially in specific instances where the nominee has excelled or achieved goals through courageous endeavours in spite of setbacks.
How did you hear about the Salute to Courage Award/Dinner?

Verification

Security Code:
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2010 Salute to Courage Nomination Form

Nominations must be received by July 9, 2010

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