2014 Nomination Form | Harlequin More Than Words

1. Your Contact Information

Title
First Name
Last Name
Email
Street Address
Street Address 2
Optional
City
State/Province
ZIP/Postal Code
Country
Phone Number

2. Nominee's Information

Title
First Name
Last Name
Project or Initiative
Project Location
Associated Charity
Charitable Reg Number or Non-profit org Number
How long has the nominee been helping this charity?
Charity's Website

3. Nominee's Story

What is the Charity's mission or vision statement (i.e., the Charity's purpose, goals, values and vision for the future)? 150 Words or Less

words. Please limit to 150 words or less.

How is the Nominee involved in the Charity's work?250 Words or Less

words. Please limit to 250 words or less.

What motivates the Nominee to help this Charity?250 Words or Less

words. Please limit to 250 words or less.

How are you inspired by the Nominee?300 Words or Less

words. Please limit to 300 words or less.

How does the Nominee inspire others to get involved?250 Words or Less

words. Please limit to 250 words or less.

What impact could this award have on the Nominee, the Charity and the community they serve?300 Words or Less

words. Please limit to 300 words or less.

How did you find out about the Harlequin More Than Words program?This question does not have any bearing on the assessment of your nomination

Other:

4. Submit

By submitting this nomination, I acknowledge that I have read and understood the Official Rules and agree to be bound by them.

Before you press the Nominate button, please make sure the contact information you entered above is accurate.

Please note: Submitting the same nomination more than once causes delays, so please resist the urge to send us your nomination multiple times. Thank you.