2023 American Heart Association Tri-County Woman of Impact Nomination Form

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*American Heart Association's (AHA) Mission: To be a relentless force for a world of longer, healthier lives

The Woman of Impact 9-week campaign brings together changemakers from across the country dedicated to making a lasting impact on the health of women in our community and beyond through sharing their stories, their why, and spreading awareness of the #1 killer of women: heart disease.

Each year a group of women in our area are selected to be a part of this initiative because of their passion and drive to make a difference. Nominees may bring together their own network to form an impact team, set a goal, explore fundraising resources, and make a difference in the lives of others.

This special group of women will be celebrated for the overall impact they have on our mission and community. In addition, the woman who brings her network together to have the largest impact will be named the 2023 Tri-County Woman of Impact Award winner.

Do you know an individual in the Tri-County area that would make a great 2023 American Heart Association (AHA) Woman of Impact Nominee?

Please complete the form below.

Nominee's First & Last Name

Nominee's Company Name & Job Title

Nominee's Phone Number & Email Address

Question 1: How does this woman incorporate the mission of the AHA in her life? *Mission statement stated above.

Question 2: How does this woman make an impact in her community?

Question 3: What qualities does this woman possess that would make her an excellent nominee?

Question 4: What community activities is this woman involved in?

Additional Comments

Your First & Last Name

Your Phone Number & Email Address

Your Company & Job Title

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