Real Heroes Nomination Form | ARC Summit County

Type of Hero (Select One)*	Medalist Hero: A Portage 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 Portage 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 (example: fireman, policeman, 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 (example: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 Number
Nominator's Email Address
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