2008 American Cancer Society Allen County Appreciation Dinner
Volunteer and Cancer Survivor Nominations
As stated by its mission, the American Cancer Society “is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service.”
Achieving the American Cancer Society (ACS) mission depends on the commitment of many individuals who go unrecognized for their selfless work. On Thursday, May 22, 2008, the ACS will host its first Appreciation Dinner in Allen County at the Shawnee Country Club in Lima, Ohio. This dinner will honor volunteers and cancer survivors and show our gratitude for their achievement, compassion, courage and inspiration in advancing the cause of the ACS. One volunteer and one cancer survivor who exemplify exceptional commitment of service and achievement will receive a special award.
We are currently accepting nominations for these awards. Please consider the following criteria in determining whether a particular person is eligible for nomination:
Eligibility Criteria for Volunteer
- Outstanding commitment to the ACS mission with at least one year ACS volunteer
service
- Devoted time and initiative to volunteer service in Allen County
- Volunteer achievement represents service without pay
Eligibility Criteria for Cancer Survivor
- Individual living with the diagnosis of cancer
- Provides hope, inspiration and encouragement to cancer patients and others in the
community
- Demonstrated community involvement and valuable service in Allen County
Please use the following form(s) to submit your nomination(s). The nominations will be reviewed by a panel consisting of ACS and Allen County-based healthcare and business representatives.
Submission Deadline: Friday, April 11,2008
Submit completed nomination forms to:
Jessica Stewart
Regional Community Director
American Cancer Society- Northwest Region
740 Commerce Drive, Suite B
Perrysburg, OH 43551
Nominations may also be e-mailed to or faxed to 877-227-2838 with a cover page addressed to Jessica Stewart.
To request an e-mail version of the nomination forms, or if you have any questions, contact Jessica Stewart by phone at 888-227-6446, ext. 5300, or via e-mail at .
2008 American Cancer Society Allen County Appreciation Dinner
Volunteer Nomination Form
Nominee: (American Cancer Society volunteer you are nominating)
Name ______E-Mail Address ______
Daytime Telephone______Evening Telephone ______
Address ______City/State/ZIP ______
American Cancer Society (ACS) Activities: Describe the ACS activities in which this volunteer is involved. Include the number of years of service. (you may attach one additional sheet to this form if needed) ______
______
______
Please type answers to the following questions on one sheet of 8 ½ x 11 inch paper.
1. Why does this volunteer deserve to be honored by the ACS? How has this volunteer advanced the mission of the ACS in Allen County, including
- preventing cancer/saving lives
- diminishing suffering/helping others to cope with cancer
2. In what ways is this volunteer’s service to the ACS exceptional or inspiring? Consider challenges he or she has overcome and results achieved.
3. Describe other volunteer service and accomplishments of the nominee in Allen County. How has he/she enhanced quality of life and changed the community for the better?
References: Please provide two letters of reference which support this nominee’s service and accomplishments. References may include one family member.
Nominator: (Your Name)
Name ______E-Mail Address ______
Daytime Telephone______Evening Telephone ______
Address ______City/State/ZIP ______
Signature ______
2008 American Cancer Society Allen County Appreciation Dinner
Cancer Survivor Nomination Form
Nominee: (cancer survivor you are nominating)
Name ______E-Mail Address ______
Daytime Telephone______Evening Telephone ______
Address ______City/State/ZIP ______
Nominee’s Cancer Journey: Briefly describe this survivor’s cancer journey, including date of cancer diagnosis. (you may attach one additional sheet to this form if needed) ______
______
______
Please type answers to the following questions on one sheet of 8 ½ x 11 inch paper.
1. Why does this survivor deserve to be honored by the ACS? How has he/she changed the Allen County community for the better?
2. In what ways is this survivor’s service & accomplishments exceptional or inspiring? Consider challenges he or she has overcome and results achieved.
3. How has this survivor advanced the mission of the ACS in Allen County? Consider how this person has impacted or touched the lives of cancer patients and others in the community.
References: Please provide two letters of reference which support this nominee’s service and accomplishments. References may include one family member.
Nominator: (Your Name)
Name ______E-Mail Address ______
Daytime Telephone______Evening Telephone ______
Address ______City/State/ZIP ______
Signature ______