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About the Award ~ Award Criteria ~ Submit a Nomination

Nomination Form

Nominations are due on or before October 23, 2015.

DOWNLOAD FORM HERE or Submit Online Using the Form Below:

NOMINEE INFORMATION

Nominee Name:
Employer:
Position:
Business or Home Address:
Phone: (Cell or Home)
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Phone: (Work)
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Fax:
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E-mail:

SUMBITTED BY

Name:
Title:
Business Name/Organization (as applicable):
Address:
Phone: (Cell or Home)
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Phone: (Work)
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Fax:
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E-mail:
Relationship to Nominee (friend, co-worker, etc.):

APPLICATION QUESTIONS

1) Please describe how your nominee (Senior Organizational Leader) has supported the organization’s “Corporate Citizenship” objectives through the United Blood Services/Arizona (UBS/AZ) community blood program. Please provide specific examples on how the organizational leader sees UBS/AZ fitting into those “Corporate Citizenship” objectives through blood drives, community partnerships and/or awareness campaigns.
2) How does your nominee play an active role in the success of the UBS/AZ community blood program within the organization, its management team and/or work with blood drive coordinators? Please provide specific examples that demonstrate how they support and encourage participation.
3) What personal and leadership characteristics does your nominee possess that contribute, encourage and inspire the organization’s commitment to the UBS/AZ community blood program?
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