Question Title

* 1. Please provide the first and last name of the person being nominated.

Question Title

* 2. What is the phone number for the person being nominated?

Question Title

* 3. What is the email for the person being nominated?

Question Title

* 4. What is your first and last name?

Question Title

* 5. What is your phone number?

Question Title

* 6. What is your email?

Question Title

* 7. How do you know the person you nominated?

Question Title

* 8. This award recognizes the hard work and commitment of a person who contributes to the benefit of those living with HIV/AIDS in South Central Indiana. Please describe how the person you nominated benefits a person, or people, living with HIV/AIDS in South Central Indiana.

Question Title

* 9. The recipient of the award will be a person that consistently shows compassion, concern, empathy, understanding, advocacy and commitment for individuals that have been affected by the disease. Please provide examples of how the person you nominated demonstrates this.

Question Title

* 10. The title of the award is the Celia Busch Making a Difference Award. Please provide specific examples that illustrate the nominee’s commitment to making a difference to people living with HIV/AIDS.

Question Title

* 11. Please provide anything else you would like the committee to know about the nominee and why you think he or she deserves the award.

T