Please complete the nomination form to the best of your knowledge. Include as much information as you can about the positive change this individual has helped to create in Northwest Illinois. Your Name * Your Phone Number * Your E-mail Address * Nominee's Name * Nominee's E-mail Nominee's Phone Number * Nominee's Company or Organization Role * Please indicate the role that this individual plays with the organization or organizations you listed above. Volunteer Staff Other Profile * Please provide a brief background of what you feel makes this person a "Small Town Hero". Please include the impact they have helped to create in Northwest Illinois.