CLIF Champion Award Recommendation
Please provide details regarding the Champion Award recommendation, and a CLIF representative will contact you within 48 hours.
Email address *
Name of Nominator *
Your answer
Email of Nominator *
Your answer
Date *
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Name of Nominee *
Your answer
Email of Nominee *
Your answer
Address of Nominee *
Your answer
Phone Number of Recipient *
Your answer
Has the nominee, or family member been in a distracted driving related traffic crash within the last 10 years? *
Your answer
Has the nominee, or a family member acquired financial hardships because of the accident? If so, how? *
Your answer
Has the nominee, or a family member acquired physical disabilities because of the accident? If so, how? *
Your answer
Why do you believe that the nominee should be awarded the CLIF Champion Award? (500 words or less) *
Your answer
Summarize the nominee’s previous volunteer experience. *
Your answer
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if the nominee is accepted as the award recipient, any false statements, omissions, or other misrepresentations made on this application may result in immediate revocation of the award. *
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