2025 Distinguished Humanitarian Award Nomination Form

Distinguished Humanitarian: This award is given to an individual who has dedicated their life to victim services.

Name of individual making nomination:

First Name

Last Name

Phone

(###)

###

####

Email Address

Nominee's full name:

First Name

Last Name

Nominee's email:

Provide up to three characteristics and indicate why they best describe the nominee:

Approximately how long has the nominee been involved in the victim service field?

Briefly list any agencies and or organizations the nominee has worked for and titles they’ve held (if known) within those organization(s) (include any honors and awards received):

Did the nominee develop and or implement any new services and or programs for crime victims?

If yes, describe the service or program:

Relationship with the nominee?

OPTIONAL: In 100 words or less, please summarize your reasons for nominating this individual:

2025 Distinguished Humanitarian Award Nomination Form

GIVE

CONNECT

FOLLOW