Humanitarian Award Nomination Form

Nominator Information:

Nominator Name*

First Last

Phone*

Email*

Relationship with Nominee

Nominee Information:

Nominee Name*

First Last

Class Year

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Current Employment*

Occupation Business Title

_________________________________________________________________________________________________________________

Reason for nomination (check appropriate line)*

Direct involvement in life saving rescue effort(s)
Dedication to improving the health and well-being of others.
Significant involvement preparing for, preventing or resopnding to natural / manmade disaster(s) and emergency situation(s).

This involves:*

_________________________________________________________________________________________________________________

Professional background of nominee:*

(Upload separate file if necessary - if attaching file please type "See Attached")

Attached Professional Background file upload, if necessary.

Accepted file types: pdf, doc, docx, Max. file size: 20 MB.

Allowed file types: PDF, doc, docx

Please provide thoughtful and detailed summary of support for the nominee:*

(Upload separate file if necessary - if attaching file please type "See Attached")

Attached Summary of Support file upload, if necessary.

Accepted file types: pdf, doc, docx, Max. file size: 20 MB.

Allowed file types: PDF, doc, docx

Resulting recognition, honors, and/or accolades:

We welcome letters of support, eyewitness accounts, magazine, newspaper or online accounts and relevant articles.

(Upload separate file if necessary - if attaching file please type "See Attached")

Supporting Documentation file upload, if necessary.

Accepted file types: pdf, doc, docx, Max. file size: 19 MB.

By checking the box below, I hereby acknowledge that my submission of this form shall be considered my nomination for the Alumni Humanitarian Award.*

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Email

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Maine Maritime Academy