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2023 People of Courage Award Nomination Form

Awardees will be honored at the Safe Homes Gala on April 14, 2023

Nominator Information (Your Information)

Please fill out the information below for the Safe Homes Advisory Committee. You must be willing and prepared to comment via telephone and provide more detailed information about the nominee. You will only be contacted if your nominee is chosen as a finalist. 

* Nominator Name
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* Nominator Pronouns
0/50
* Nominator Address
0/50
* Nominator Email Address
0/50
* Nominator Phone Number
0/50

Nominee Information

Nominee will be contacted in January if they are chosen as a finalist.

* Nominee Name
0/50
* Nominee Pronouns
0/50
* Nominee City/Town
0/50
* Nominee Email Address
0/50
Nominee Phone Number
0/50
* Award Category (Check Only One)
If you selected "Create Your Own," fill in the proposed award category here
0/50
* Does the nominee have a connection to LGBTQIA+ work being doing in Massachusetts?
* Does the nominee demonstrate commitment to serving as a role model for LGBTQIA+ youth/adults or other marginalized group?
* Does the nominee show distinguished contribution to the LGBTQIA+ community?
* Does the nominee show demonstrated commitment to advocating for equal rights and social justice for all?
* Do you believe the nominee will agree to be recognized by Safe Homes for their contributions and this achievement at public events and in the media?
* Tell us more about the nominee - Why do they deserve this award?
0/500
Is there someone else who should be contacted for more details on the nominee? If so, please provide contact information. (Optional)
0/250