The Russ Berrie Award for Making a Difference || Nomination Form

Return to Main Page

Nominations for the 2008 Russ Berrie Award for Making a Difference will be accepted until March 14. New Jerseyans who have made a significant difference in their communities through a heroic effort or a lifetime of service are eligible. Use the form that follows to nominate someone who has made a difference.

PLEASE RETURN FORM POSTMARKED NO LATER THAN MARCH 14, 2008 to:

The Russ Berrie Award for Making a Difference
c/o Dr. Peter P. Mercer, President
Ramapo College of New Jersey
505 Ramapo Valley Road
Mahwah, New Jersey 07430-1680

Russ Berrie Award for Making a Difference Nomination Form (PDF)

Please Type.

Nominator
Name:_____________________________________________ Circle One: Mr./Mrs./Miss/Ms.
Address:_____________________________________________________________________
City:___________________________State: _________Zip:__________Country:___________
Telephone/Fax: _______________________________________________________________
Title:________________________________________________________________________
Occupation:__________________________________________________________________
Business Address: ____________________________________________________________ ____________________________________________________________________________
____________________________________________________________________________
Telephone:__________________________ Fax:_____________________________________
E-Mail:______________________________________________________________________
How did you learn about the "Berrie Award?" Direct Mail:_____ Newspaper/Radio Ad:______
Past recipient:______ Other:_____________________________________________________
Can we contact the nominee if additional information is required?_______________________
To the best of your knowledge, has this person been previously nominated?______________

Person Nominated
This information must be complete. Former Berrie award winners are not eligible.
Name:_____________________________________________ Circle One: Mr./Mrs./Miss/Ms.
Address:_____________________________________________________________________
City:___________________________State: _________Zip:__________Country:__________
Telephone/Fax: _______________________________________________________________
E-Mail:______________________________________________________________________
____________________________________________________________________________

Title:________________________________________________________________________
Occupation:__________________________________________________________________
Business Address:____________________________________________________________
____________________________________________________________________________
Telephone:__________________________ Fax:_____________________________________
E-Mail:______________________________________________________________________
Date/Time Period "unsung hero" made a difference: _________________________________

How many years have you known the nominee, and in what capacity?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Please Type:
In 200 - 400 words, describe the reason for this nomination. Please be sure to describe the actions that warrant the nomination and tell us in what way the person is an "unsung hero." Please comment on the following in your response.

The Contribution this individual has made to society and what impact it has made.
The outstanding, uncommon and unique qualities, skills and abilities that make this individual an "unsung hero."

If the reason for this nomination is community service, please comment on the individual's vision, leadership abilities, creativity and initiative for what they are seeking to accomplish.

If the Reason for nomination is a single act of heroism, please comment on the individual's initiative, motivation and the degree of risk involved in the act.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Please limit attached supplementary materials (such as news accounts) to no more than four pages in support of this nomination. This allows a stronger consideration of your nomination.

I have attached _____ pages of supporting materials to this nomination form.