NextUp Awards Nomination – Chicago Nominee Name (required) Nominee Birthdate (required) Nominee Home Address (required) Nominee Phone Number (required) Nominee Email Address (required) Nominator Name (required) Nominator Organization Nominator Title Nominator Home Address (required) Nominator Phone Number (required) Nominator Email Address (required) NOTE: Please answer the following questions in as much detail as possible (total character limit of 2,500 for all responses). 1.) PLANNING (0-10 points): Please describe in detail the nominee's philanthropic activity. Include purpose, goals, planning, process, budget (if applicable), and the names and contact information of other people involved in the effort. 2.) RESULTS (0-10 points): Please provide details on the results of the effort or initiative in terms of community impact. How did it accomplish its stated goals? How was the impact of the effort measured? Please also include the name(s) and contact information of individuals or groups who benefited from the initiative. 3.) LONG-TERM VIABILITY (0-5 points): Please offer details on the potential long-term impact of the initiative. In what way will it produce ongoing results? Does the project continue, and if so, how is it being sustained? 4.) ABILITY TO REPLICATE (0-5 points): Please offer details on how the program could serve as a prototype for other communities. By submitting this form, I certify that the above-named individual is hereby nominated for The NextUp Awards. I also certify that the nominee meets all eligibility requirements. I further authorize Blood Science Foundation to publicize this information in ways that are appropriate to help create visibility for The NextUp Awards and the foundation. I Agree
