Amanda Dempsey Award Nomination Form | Cancer Care & Support

Dempsey Center›About›Amanda Dempsey Award›Amanda Dempsey Award Nomination Form

Amanda Dempsey Award Nominations

Your Name(Required)

Phone Number(Required)

Email Address(Required)

Does your nominee know you are nominating them for this award?(Required)

Yes

Nominee Name(Required)

Town/City of Residence(Required)

Email Address(Required)

Phone Number(Required)

The nominee meets the following criteria for the Amanda Dempsey Award(Required)

They are a cancer survivor.

They have demonstrated a passion for helping and inspiring others impacted by cancer.

The individual lives and/or helps others in the state of Maine

Please select all that apply. Nominees must meet all three points.

Tell us about the nominee's cancer experience(Required)

Describe the concrete ways this person has demonstrated a passion for helping and inspiring other people diagnosed with cancer.(Required)