Cleveland Heritage Medal Nomination Form The Cleveland Heritage Medal Nominating Committee is pleased to accept candidate nominations for this year’s awards process. Nominations are due no later than Friday, April 14, 2023 and may be submitted by this online form or by emailing a nomination form to Barbara Kakiris at bkakiris@metrohealth.org Following a rigorous nomination and selection process that culminates in summer of each year, several individuals are chosen by the Cleveland Heritage Medal Committee to be so honored. These men and women are true representatives of leadership in Cleveland and the region, their impact far exceeding that which would be expected of them in their positions of influence. But for them, the magnificent story and history of Cleveland would not be what it is today Nomination Critieria: All entries must be completed in full and submitted electronically. Submissions on paper are not accepted. Nominations made anonymously will not be accepted. Only living individuals can be nominated. Honorees are chosen during their lifetime and will have been active members of the community for a minimum of 10 years. Honorees will not be current elected officials. Only one nomination per form will be accepted. The nominations of couples, families or organizations will not be accepted. Nominated By Name * Email * Phone * Company Name (if applicable) Title (if applicable) Mailing Address A member of the Cleveland Heritage Medal Committee may contact you for more information about the person you are nominating. Candidate Information Candidate Name * Career or Community Affiliation * Primary CHM Category Represented (Select One) CivicCorporatePhilanthropyOther Significant Public or Private Endeavor If other please describe CHM Criteria and Core Values Represented (Select as many as apply) Service to Others (Strives to meet the needs of others first, by serving with compassion and advocating for the well-being of the community)Teamwork (Establishes an environment of trust and engagement that focuses on the needs of the community and leverages collective strengths to do the right thing)Courage and Respect (Accepts responsibilities for decisions made, outcomes achieved and personal behavior.)Inclusion and Diversity (Fosters a community where differences are celebrated and everyone has the opportunity to be successful.)Role Model (Exemplifies the highest standards and continually works to improve.) Nominator Narrative Please provide a brief narrative that reflects how the nominee during his/her career or volunteer tenure has demonstrated the Heritage Medal criteria and core values highlighted above. This may include examples of exceptional leadership skills and impactful achievements; corporate social responsibility initiatives; community service and nonprofit involvement; awards and recognitions; and philanthropy. If possible, please identify one or two transformative or legacy achievements that may distinguish this individual from other nominees. Nominator Narrative* You may attach no more than three supporting documents (doc, docx, pdf or jpg) to accompany the nominator narrative. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.