Tobacco Free Advocate of the Year Award - 2020 Nomination Form
Please use this form to nominate an individual for the Tobacco Free Advocate of the Year Award.

The nominated individual must be doing active tobacco-free work in Allegheny County, PA during the course of 2019 and/or 2020 to be considered for the award.

All nominations must be submitted no later than November 1, 2020.
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Your name (First, Last) *
Where do you work?
Your phone number: *
Your email address: *
Best way for us to contact you: *
Who are you nominating? *
With what agency are they employed?
How has this person contributed to tobacco education, prevention and cessation in Allegheny County? *
How may we best contact the individual you are nominating? *
Phone number (of the person being nominated) *
Email address (of the person being nominated) *
Would you like your nomination to remain anonymous?
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