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. Nomination due: Friday, July 26th, 2019 @ 10am 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 background of what you feel makes this person a "Small Town Hero". Tell us your relationship to the person, and their relationship in our community. How many years has this person been involved and engaged in making change in our community. * How many lives has this persons efforts impacted? And what has the impact been? * How has this individuals efforts made a difference in the community as a whole? * What lasting change has our community seen because of this individuals efforts? * What makes this individuals efforts stand out above others? * How has this individual inspired others to engage in our community? * Do they represent a cross sector of our community? * What does this individual do that is over and above what is required of them? * What does this individual do that exemplifies the qualities of a servant leader?