All information provided will be viewed by PHW Staff and Selection Committee.
IMPORTANT: The nomination process requires two submissions - a written submission via the form below and a video submission by September 13, 2024. For detailed information, visit Hereos for Young Hearts. To be considered by the Selection Committee, nominations should be for one (1) individual per category (no groups) and must include specific details about the actions taken by the nominee between October 2023 and September 2024 to support the PHW mission (i.e., research that helps advance our cause, organized 3 community heart screening events, placed 50 AEDs, trained others in CPR & AED use, etc.)

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* 1. Full Name of Person Completing Nomination Form

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* 2. Street Address

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* 3. City, State & Zip Code

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* 4. Email Address

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* 5. Mobile Phone Number

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* 6. Nominee #1 - Select award category

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* 7. Nominee #1

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* 9. Nominee #1

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* 10. Specific details of actions by Nominee #1 (i.e., research that helps advance our cause, organized 3 community heart screening events, placed 50 AEDs, trained others in CPR & AED use, etc.)

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* 11. Nominee #2

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* 13. Nominee #2

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* 14. Specific details of actions by Nominee #2 (i.e., research that helps advance our cause, organized 3 community heart screening events, placed 50 AEDs, trained others in CPR & AED use, etc.)

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* 15. Nominee #3 - Select award category

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* 16. Nominee #3

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* 18. Nominee #3

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* 19. Specific details of actions by Nominee #3 (i.e., research that helps advance our cause, organized 3 community heart screening events, placed 50 AEDs, trained others in CPR & AED use, etc.)

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* 20. Nominee #4 - Select award category

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* 21. Nominee #4

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* 23. Nominee #4

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* 24. Specific details of actions by Nominee #4 (i.e., research that helps advance our cause, organized 3 community heart screening events, placed 50 AEDs, trained others in CPR & AED use, etc.)

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* 25. Nominee #5 - Select award category

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* 26. Nominee #5

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* 28. Nominee #5

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* 29. Specific details of actions by Nominee #5 (i.e., research that helps advance our cause, organized 3 community heart screening events, placed 50 AEDs, trained others in CPR & AED use, etc.)

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