Small Town Hero 2025 Nomination Form | United Way of Northwest Illinois

Your Name

Your Phone Number

Your E-mail Address

Nominee's Name

Nominee's E-mail

Nominee's Phone Number

Nominee's Workplace or Organization

Where does this individual volunteer?

How long have you known the nominee?

What is your relationship with the nominee?

Please share with us what this individual is doing in the community that promotes positive change.

What impact is being made through this individual's efforts?

How does this individual's efforts stand out above others? Be Specific.

How has this individual inspired others to engage in our community? Be Specific.

Which sectors of our community does this individual represent?

Please share a story of how this individual's efforts exemplify the qualities of a servant leader.