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Humanitarian Award

Human Relations Advisory Group 
Humanitarian Award 2019 Nomination Form

Purpose:
The Highland Park Human Relations Commission (HRC) has established the "Highland Park Humanitarian" award to recognize an individual resident who has rendered outstanding service to the Highland Park community, beyond the scope of his/her paid work environment. Any Highland Park resident who has a record of significant and sustained service and has, through his/her efforts made a substantial contribution to changing lives in the Highland Park Community may be nominated. Areas of service may include but are not limited to: charitable work, education, environmental advocacy, public policy, and promoting the welfare of this community and its residents.

Nomination Criteria:

Individual who resides in Highland Park
• Who has a record of significant and sustained service
• Whose service reaches beyond the scope of his/her paid work environment
• Whose efforts made a significant contribution to changing lives in Highland Park
• Areas of service may include, but are not limited to: Charitable work, Education, Environmental Advocacy, Public Policy, and Promoting the welfare of this community and its residents
• Nominations must be submitted by someone other than family of the nominee

Nominations should include:
Service Details
• Agency Name Title(s) Held, Dates of Service, Service Provided, Service Recipients, and Description
• Nominee’s Character

Personal attributes and Worthiness of the award:
• Additional Information
• No additional information or documents will be accepted

Nomination Instructions:
Please submit the nomination form below
Please complete the application in one sitting as you are unable to save progress
Please provide contact information for up to three (3) individuals for support varification of this candidate

Evaluation Process:
1.The City of Highland Park’s Human Relations Advisory Group will review all nominations, comlete and submit a Likert Scale for each, adn the compiled data will be submitted to the Mayor and City Council for selection of the award recipient.
2.The Humanitarian Award Recipient is invited with family and friends to an awards ceremony at the Highland Park High School on Wednesday, May 15, 2019.
3.Please, no lobbying. Refrain from calling members of the HRAG regarding nominations.

Nominee Information:

Name:

Address:

City or Town:

State or Province:

Zip or Postal Code:

Phone:

Email:

Place of Employment or School:


Employee:      Business owner:      Resident:      Student:

Nominator's Information:
Name:

Address:

City or Town:

State or Province:

Zip or Postal Code:

Phone:

Email:

Relationship to the Nominee

Number of years Acquainted


If this nominee is not selected as the Humanitarian Award recipient, and if this nominee has not already received a Character Counts Award, would you like him/her to be considered for a 2019 Character Counts Award? 

Yes:     No:

Please share highlights from the nominee's substantial and sustained service:
Agency Name
    
Title(s) Held

Dates of Service

Service Provided

Recipients

Description (100 words max)


Agency Name

Title(s) Held

Dates of Service

Service Provided

Recipients

Description (100 words max)


Agency Name

Title(s) Held

Dates of Service

Service Provided

Recipients

Description (100 words max)


Agency Name

Title(s) Held

Dates of Service

Service Provided

Recipients

Description (100 words max)


Agency Name

Title(s) Held

Dates of Service

Service Provided

Recipients

Description (100 words max)


Agency Name

Title(s) Held

Dates of Service

Service Provided

Recipients

Description (100 words max)


Describe the nominee's personal character and worthiness of the award (250 words max)


Additional Information (250 words max)



Please provide contact information for up to three (3) individuals to provide verified support for this candidate from organizations, businesses, or individuals with which the nominee is affiliated.


Verified supporters


Name

Phone

Email


Name

Phone

Email


Name

Phone

Email