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Nominees for the HERO Riverside Medical Clinic Charitable Foundation

Nominees for the HERO Riverside Medical Clinic Charitable Foundation

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The Anti-Bullying Institute will choose an individual, school, or community group that has shown exceptional efforts in being kind, inclusive, and aiding to end bullying in their school, place of work, and/or community. Promotional materials, certificates and special recognition will be awarded to the winners.

You can submit nominations for this quarter in the following categories:
HERO Student, HERO Teacher/Administrator, and HERO Community Member
Please fill out a form and submit it via email to bianca@rmccharity.org by 5:00 p.m. on January 28th, 2019.

Please call Bianca Gonzalez, ABI Program Coordinator at 951-321-6512 with any questions.

*If more than one individual/group is being nominated at your school site or organization, please note down all of their information on one form. Multiple nominations will be taken into consideration based on funds and availability.
(e.g., multiple students/teachers, community group, etc.)

1. I am nominating _______________________________________________ for:

(Please check one)

The HERO Student Award

The HERO Teacher/Administrator Award

The HERO Community Member/Group Award ______

Nominees shirt size (e.g., Youth S, Adult L) ______
(If a group is awarded other promotional items might be awarded)

This/These individual(s) has taken action to prevent or change an action or behavior that physically or emotionally hurts, harms, or humiliates someone. This person/group has demonstrated outstanding act(s) of being helpful and kind. This individual/group has looked beyond the differences of others and celebrated what makes everyone unique. He/She/They have contributed to making an inclusive environment and has done an outstanding act to help others feel like they belong and know that they are not alone. This/These individual/group resides/meets in Riverside County.

2. Why are you nominating this individual/group for this award?

3. Please share why this individual/group is deserving of this award above other HEROES at your school or in our community.

Nominee (person/group being nominated) Contact Information:
Name:
Address:
City:
School and District (if applicable):
Parents Name (for student nomination, if applicable):
Email Address:
Phone Number:

Nominator (person nominating) Contact Information:
Name:
Address:
City:
School/District (if applicable):
Email Address:
Phone Number:

Please make sure we have contact information during summer months for notification and celebration information.

The Anti-Bullying Institute and Riverside Medical Clinic Charitable Foundation has my permission to post my nomination on their website and/or social media, with my name and school site information included.
Yes
Yes, without last name included
No
If nominating a student, is he/she still currently enrolled in this school?
Yes
No
Will be/Attending College
Would you like to be added to our Email list and receive Anti-Bullying information?
Yes, sign me up!
Email Address:

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