HEROES 2011

Nomination Form
The Delaware Valley Legacy Fund (DVLF) seeks to identify youth (21 and under), adults, non-
profits, and businesses who have bold ideas, act with selfless intention, are admired for their
integrity, and are regarded as courageous in advancing the equality of the lesbian, gay, bisexual,
transgender and intersex (LGBTI) community in the Delaware Valley and beyond. Those
possessing these traits are Heroes.

DVLF honors these Heroes annually in celebration of their character and in encouragement of
others to act heroically. Heroes are nominated by members of the community and selected by the
Outreach and Grantmaking Committee of DVLF upon approval of the DVLF Board of Directors.
Anyone may nominate a youth, adult, non-profit, and/or business Hero. Decisions are based on the
quality of the nomination, rather than the number submitted. A person or organization’s entire
history is considered, with an emphasis placed on heroic activities in the past year.

To nominate a Hero, please provide the following information and submit via e-mail to
info@dvlf.org or mail to the address below by March 18th, 2011. Please use separate forms for
each nomination. Self nominations are not permitted.

Your Information

Name ________________________________ E-mail _____________________________

Mailing address ________________________________________________________________

Phone ________________________________ Fax ________________________________

Nominee’s Information

Nominee _____________________________ Please circle: Adult Youth (21 or under)

Non-Profit Business

Contact ______________________________ E-mail _____________________________

Mailing address ________________________________________________________________

Phone _______________________________ Fax ________________________________

1234 Market Street, Suite 1800 Philadelphia, Pennsylvania 19107

(215) 563-6417 Fax: (215) 563-6882 www.dvlf.org
Using the space provided, tell the Committee why you believe the adult, youth, non-profit or
business you are nominating is a Hero. Please refer to the top of the first page for a definition, and
be sure to emphasis their contributions to the community over the past year. If you are nominating
a non-profit or a business, please include a copy of their non-discrimination policy and/or policies
related to the LGBTI community, if available.

1234 Market Street, Suite 1800 Philadelphia, Pennsylvania 19107

(215) 563-6417 Fax: (215) 563-6882 www.dvlf.org