BCBSLA - Angel Award Nomination Form

The Angel Award
Angel Award Nomination Form

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Fill out the form below to nominate someone for the Angel Award. The deadline for nominations for the 2010 Angel Award is May 14, 2010.

Before you start, be sure to read over the rules and regulations to make sure your angel qualifies for our award. Here are some other tips:

You can send us additional information that shows your angel's good works, such as newspaper clippings, photographs, letters of support, videotapes, etc. Sorry, we can't return this information, so make a copy for your records.
Send additional information to the address below. Be sure to label any supplemental materials with your nominee's name as well as your name.
You can choose to send us your nomination and other information by mail to:

The Angel Award
P. O. Box 98029
Baton Rouge, Louisiana 70898-9029
If you still have questions, call our Angel Award info line at 1.888.219.BLUE (2583) or e-mail us at angel.award@bcbsla.com.

*Required Field.
**If known. Needed for recordkeeping purposes and will be verified if nominee is selected.

	Nominee		Nominated by
	First Name:*		First Name:*
	Last Name:*		Last Name:*
	Address:*		Address:*
	City:*		City:*
	State:*		State:*
	Zip:*		Zip:*
	Telephone Number:*		Telephone Number:*
	E-mail Address:		E-mail Address:
	Date of Birth:**		Relationship to Nominee:
	Nominee's Chosen Charity:**

	What does the nominee do to serve Louisiana children?*

	Did the nominee initiate new programs or activities and use new methods to solve problems?*

	Has the activity or service provided by the nominee produced positive changes and provided examples for other groups?*

	What results has the nominee produced?*

	What amount of time does the nominee devote to the activity or service?*

	Was the nominee active, not a figurehead?*

	Has the nominee overcome unusual challenges, such as limited resources, public perceptions of the problem or a personal disability?*