Acts of Courage Nomination Form

Type of Hero (Select One)	Medalist Hero: A Summit County citizen who puts their life at risk to save the life of another or assist in a life threatening situation (examples: running into a burning house, pulling someone out of a burning car, rescuing someone drowning, etc.). Distinguished Hero: A Summit County Citizen who saves the life of another or assists in a life threatening situation (examples: performs CPR, choking maneuver, administers First Aid, etc.). Professional Rescue Hero: A professional worker who goes above and beyond the call of duty to save the life of another while on the job - this includes those individuals who volunteer their services (examples: firemen, policemen, paramedics, nurses, doctors, etc.). These will be chosen by a professional peer review committee. Animal Hero: An animal who deserves recognition for assisting in saving the life of a human (examples: police dog who saves a handler, seeing eye dog who rescues an owner, etc.).
Hero Name:
Hero Age
Hero Address:
Hero City/State/Zip
Hero Email
Hero Phone Number
Hero Occupation and Employer
Spouse/Parent/Guardian
Individual Nominating Hero
Nominator's Phone:
Nominator's Email:
Victim's Name
Victim's Address:
Victim's Phone Number
Victim's Email
Date of Heroic Act:
Victim's Relationship to Hero
Date and Location of Incident
Description of Heroic Act: