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2006 Safety Education Hero Award

Description of Nomination (i.e., life saved, type of injury prevented, etc):

Nominee Information
Name:
Title:
Organization or Employer:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:

History, experience, and training of Nominee in the area of public fire and life safety education:

Nominator Information (if other than Nominee)
Name:
Title:
Organization or Employer:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:

Nomination
Names of person/persons whose lives were saved or whose injuries were minimized as a result of appropriate response to an emergency:
(Please include names and contact information)
Program Summary
Please attach a summary of your public education program and the extent of involvement with the person(s) named above with that program. Please limit your summary to 250 words or less.

Please attach a Word document:

The summary should include all pertinent information regarding your program success, including the trade name of the educational program you used, if any. Please also provide all relevant names, date(s) and location(s) of event(s).
Incident Summary
Please attach a summary of the incident in which the person(s) named above reacted appropriately to a home emergency situation. Please limit your summary to 250 words or less.

Please attach a Word document:

Supporting Materials
If you have any supporting materials please include them. Especially helpful are the following:
  • news coverage of the incident
  • photographs
  • video footage
  • the educational program you used and/or your lesson plan(s)
  • scripts or speaking points you used during the program
Please attach additional documents:
File 1:
File 2:
File 3:
File 4:
File 5:

If you have any trouble submitting your application online, please mail your application to the Home Safety Council

 

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