St. Louis Area Chapter Volunteer & Community Partner Awards 2013 Survey

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* 1. Nominee's Name (Nominee must be a currently active Red Cross volunteer or community partner in good standing)

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* 2. Nominee's primary program area of service (you may choose more than one if the nominee is active in that area)

Disaster Services

Preparedness, Health & Safety Services

Biomedical/Blood Services

Administrative Services

Board/Committee Member

Youth Services

Other (if "Other" is selected, please list below)

Other?

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* 3. Nominee's

Address: *

City/Town: *

State: *

ZIP: *

Email Address:

Phone Number: *

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* 4. Nominee's primary location of service:

St. Louis Area Chapter Headquarters

Southern Illinois-Fairview Heights Branch Office

Jefferson County Branch Office

Scott AFB Branch Office

Metro West Branch Office

MO/IL Blood Services

Little Egypt Branch Office

Southern Illinois-Centralia Branch Office

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* 5. How long has the nominee been an active voluteer or community partner?

Under one year

1-3 years

4-6 years

7-10 years

10-14 years

15-19 years

20-14 years

25-29 years

30+ years

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* 6. Award for which you are nominating this individual or group (only select one. To nominate an individual or group for more than one award please submit a separate nomination for each award category.):

Ann Magnussen Award - presented to a registered nurse who has made an outstanding contribution to strengthening or improving American Red Cross programs and services.

Blood Drive Volunteer Award - recognizes outstanding Blood Services volunteer commitment to providing support at local blood drives and/or donor centers. This volunteer goes above and beyond to strengthen or improve services provided to the community.

Charles R. Drew Award - . This award may be presented to either an employee or volunteer who has made an outstanding contribution to strengthening or improving Blood Services. The Charles R. Drew Award is designed to preserve the memory of Dr. Drew's contributions to the American Red Cross Blood Services.

Clara Barton Volunteer Leadership Award - The Clara Barton Volunteer Leadership Award may be given to a volunteer for distinguished service in a number of leadership positions held over a period of years and/or distinguished volunteer service performed at the chapter level or beyond for several years.

Community Partner Award - This award is given to a community partner who exemplifies cooperative partnership and has demonstrated outstanding support for the work of the American Red Cross at the local, regional or national level. They should also promote collaborative work between employees and Volunteers and/or group of volunteers and exemplifies our mission.

Disaster Response Volunteer Award - The recipient of the Disaster Response Volunteer Award will have made a measurable impact on the American Red Cross and the community and clients we serve. Primary consideration will be given to actions of merit undertaken within the past calendar year, but the total years of service and combined impact on disaster-related activities will also be taken into account.

Good Neighbor Award - This award is presented to an individual, business and/or organization outside the American Red Cross for having made a significant humanitarian contribution to the community in support of the American Red Cross.

Honorary Service Award - This award recognizes continued outstanding volunteer commitment, performance or impact. Thanks to this recipient the St. Louis Area Chapter and/or the Missouri/Illinois Blood Services Region functions efficiently day in and day out.

New & Outstanding Volunteer Award (NOVA) - This award is presented to an individual who has been with the Red Cross for less than 18 months but has made outstanding contributions to strengthening or improving services provided to the community.

Preparedness and Health & Safety Award - The Preparedness and Health & Safety Services (PHSS) Award is presented to a Red Cross volunteer whose outstanding contributions have led to the expansion and improvement of American Red Cross PHSS programs to the public at the local, regional, or national levels.

Samuel Gompers American Red Cross Labor Award - The Samuel Gompers American Red Cross Labor Award is presented to an active or retired labor union member or to a labor union organization for exemplary volunteer service given through the American Red Cross.

Services to the Armed Forces Award - The Services to the Armed Forces Award may be presented to a volunteer who has made an outstanding contribution to strengthening or improving Services to the Armed Forces.

Volunteer Fundraiser Award - The Volunteer Fundraiser Award recognizes the Volunteer, group, business or organization, which best exemplifies the spirit of charitable giving. This group demonstrates exceptional leadership in coordinating, motivating and successfully completing fundraising efforts for American Red Cross operations, programs and services.

Youth Volunteer Award - This award is given to a youth volunteer (age 25 and under) who has embraced the values of the American Red Cross and demonstrates their commitment through leadership and dedication.

Volunteer of the Year Award - The Volunteer of the Year Award honors the volunteer with the single most profound impact on Red Cross programs or services in the St. Louis Area Chapter/Missouri/Illinois Blood Services Region’s jurisdiction within the previous year.*Volunteers may win this award only once.

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* 7. Statement of nomination: Please describe in detail why you feel this person is deserving of a Red Cross volunteer award. Be factual and concise and include specific information where possible. For example, include information on the result or impact the volunteer's involvement has had on the ability of the Chapter to provide service to the community and deliver the Red Cross Mission. **There is no character limit on this box! Please be as descriptive as possible, the more detail provided the easier it is for the reviewers to make an informed decision.

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* 8. Nominator Information:

Name: *

Title: *

E-mail address:

Phone Number: *

Volunteer Staff?

Paid Staff?

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* 9. Co-Nominator information (if applicable):

Name:

Title:

E-Mail Address:

Phone Number:

Volunteer Staff?

Paid Staff?